Wiki PCP treating pt for medical condition while in Psych facility

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Florida1

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We have a PCP who visits patients who are in a Psych treatment facility. My Dr is treating the patient for typical PCP stuff, ie hypertnesion, esophageal reflux, hyperlipidemia....He often bills a 99223, which Medicare has been requesting medical records on....What is the fine line between providing medical records to substantiate his claim vs. crossing the line w/ providing documentation to insurance about patient in psych setting? Often times the patient's HPI is psych related, but Dr is seeing them for other things besides psych....I am thinking that my Dr's HPI should only be related to what he is seeing the patient for, am I wrong? Where can I find guidelines related to this?

Thanks
 
Usually any records request for a patient are specific. VERY specific. If the doctor is not treating for psych issues, then they will not be included in his notes. If Medicare is the primary payer, then they have the "right" to the records. If they want to know why a patient is in the psych ward then they would send a records request to the hospital for the psychiatric notes. Chart notes can always be kept seperate also. IE: HTN in the morning visit and psych notes in the afternoon. The HPI can be listed on the bill if it will help with the other dx codes. They don't necessarily have to be billing for all of the dx codes, but you can have many listed.
 
I am correct that my physician should not be putting any dx on his visit that he is not treating them for? ie, if he is treating for hypertension, the psych dx's are irrelevant to his visit.....
 
Medicare and most insurance companies are interested in one thing....correct coding...your doctor like any other provider, can only use codes for diagnoses to which he is addressing, giving his opinion on, performing diagnostic testing on for definitive results and conditions he is treating. If he is not treating any of the other the diagnoses he cannot code them.

The exception is if the other condition is the underlying cause of his treating condition or complication causing his treating condition.

Examples

Cardiac arrest due to drug overdose due to depression

Hypertension due to pregnancy

Pre-op exam by PCP when requested by surgeon prior to surgery
You code the exam with the diagnosis for the surgery to be performed with codes...pre-op exam

Total knee replacement. DX:eek:steoarthritis
 
Per CMS: "Generally, the [HIPAA] Privacy Rule applies uniformly to all protected health information, without regard to the type of information. One exception to this general rule is for psychotherapy notes, which receive special protections. The Privacy Rule defines psychotherapy notes as notes recorded by a health care provider who is a mental health professional documenting or analyzing the contents of a conversation during a private counseling session or a group, joint, or family counseling session and that are separate from the rest of the patient?s medical record.... See 45 CFR 164.501."

In other words, HIPAA does not consider notes that contain references to mental health issues to be any more confidential than other medical notes, and you can release them in the same circumstances in which you would release the rest of the notes.

That said, your state could have more stringent rules. If you are a member of your state's medical association, you may want to see if they have a legal department that can advise you. Or you could just Google to see if your state has any statutes addressing this.

As for advising the doctor to omit this information from his HPI, that is a clinical decision that only he can make. Items in the history or ROS that are not related to the current diagnosis often are relevant to a patient's care, even though a layman (ie: a coder or office manager) may not see this.
 
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