Wiki Palmetto GBA New LCD for Outpatient Psychotherapy

[joann4_2000]

LCD A59723
LCD L39853

Is anyone else with Palmetto GBA in in the behavioral health field that is struggling with the list of covered diagnosis in the new LCD's A59723 and L39853? The CPTs included in Group 1 in A59723 include psychotherapy with and without EM services, psychotherapy for crisis, family and group psychotherapy, interactive complexity, psychiatric diagnostic evaluations, pharmacologic management, interpretation or explanation of psychiatric, other medical exam and procedures, preparation of report of patient's psychiatric status, history, treatment or progress and unlisted psychiatric service. The list of covered diagnosis covered include only 69 codes, and they are mostly limited to vascular dementias, mood and anxiety disorders with known physiological conditions, some neurocognitive disorders, alcohol abuse, and a handful of other disorders. It feels very limited and also per coding GL we are to code first the underlying condition when using any diagnosis that ends in "with known physiological conditions", but there are no diagnosis included on the list that could be the underlying condition. We have asked some of our providers to write to Palmetto, but hoping someone else can help shed some light on this with me!

 

[TThivierge]

Hi Joann
These 2 LCD polices point to only licensed psychiatrist, LPC and LCSW to do specific using of Eval MG(99201-99215) and behavior health ( CPT 90832-90847 etc) according to disease and linked by profession. MD DO NP AP can use any CPT code, but beh CPT codes for Psychiatrist (use modifier AF,AH and AJ if necessary), LCSW and LPC. If patient has chronic medical disease med record should be split in notations then discussion on each problem and list time in record. As example patient suffers with J45, I10, and E11. 9 link to CPT 99213 add minutes, then other part of record same day discuss the beh health issue of dx F31 ,G47.30, and F10. add minutes for CPT 90832. If phone patient can add modifier 93 phone or video 95 on the CPT codes but define it mode in the documentation . The clinician may decide to add assessment CPT 96151 first then do Eval mgt code next with documentation.
At times the provider need to use unspecified dx but using more detail in notes to match selected dx of stages & ranges helps a lot as acceptable. The block dx of F32, G31, I69, F02,F10. F19. F11, F12 and certain Z & R45 dx codes help compliment this too. If patient suffers with Chronic Pain Syndrome or Homelessness due to a chronic illness or blocks dx F32 or Z63 or M54 or Cancer ensure provider adds this data too. Ensure the clinician defines terms remission vs recurrent vs history of too on selection of dx codes.
I hope helped you .
Lady T