Wiki Medical Screening Exam in Behavioral Health

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sewilke

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I work for an organization that has a separate inpatient Behavioral Health Center. When a patient comes through the triage area, can a Medical Screening Examination be billed? If so, what CPT would be used? In reading the EMTALA rules, it says this is for emergency departments so I'm not sure if the triage area would qualify. Does anyone else work in Mental/Behavioral Health that can help?
 
Your admitting provider (usually a psychiatrist or psych APRN) an bill an initial hospital visit (99221-99223), having performed a medical assessment that meets the three key components. Mental Health providers cannot provide medical assessments.
 
Pam Brooks said:
Your admitting provider (usually a psychiatrist or psych APRN) an bill an initial hospital visit (99221-99223), having performed a medical assessment that meets the three key components. Mental Health providers cannot provide medical assessments.
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Thank you for your feedback Pam. We do have a mid-level who performs the initial hospital visit (99221-99223) after the patient is admitted and our psychiatrist performs the psychiatric evaluation (usually 90792) again, after admission. But they are also performing a screening exam in the outpatient triage area to see if the patient should be admitted (sometimes this is done by the mid-levels and other times by an RN or LCSW). So, just to clarify, you're saying this initial screening in the outpatient area is not a billable service?
 
An RN or LCSW cannot provide a medical assessment that is billable. It's out of the scope of their licensure.
The LCSW can do a psychiatric evaluation, but if the psychiatrist is already doing that, there's no medical necessity for another one, regardless of who performs it. And that would not include any medical evaluation, because of scope.
A midlevel could perform an outpatient E&M visit prior to admission, even if on the same DOS because it's a different place of service. The patent would then need to be admitted, but it would have to be an inpatient admission, because you can't bill two E&Ms on the same day for the same POS. But again, only an MD or NPP could do that medical assessment, not a LCSW, RN or psychologist.
 
Agree that an RN or LCSW cannot perform a medical assessment - they could triage the patient, but a medical provider would need to make the final determination to clear the patient or not.

It seems to me that the term 'medical screening exam' is causing confusion here. This is not a 'screening' in the coding sense of the word. Per the definition given in EMTALA, this is an "assessment based on the patient’s chief complaint with the intent to determine the presence or absence of an EMC" that includes "an initial exam to rule out organic causes of mental disorder". This is really not a screening from a coding standpoint in that it isn't a preventive service given to an asymptomatic patient - this is actually part of the assessment of the patient related to their complaint and presenting problem. It's a medically necessary service and should be coded as a medical E&M service, and would have to be performed by a provider with the credentials to make a medical diagnosis. In the ED facilities I've coded for, these are performed by MDs or PAs and are billed with the appropriate level of ED E&M codes based on documentation. The MD or PA addresses the medical issues, if there are any identified, then clears and/or admits the patient to the appropriate medical and mental health services.
 
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