Wiki Pre-op Bariatric Psych evals

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bridgettemartin

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Our PhD's have started doing Psych evals for patients planning to undergo bariatric surgery. We are having trouble with dx codes not being on the Medicare LCD for 90791.
We've looked into the pre-op codes, the screening codes and none are covered. Morbid Obesity is actually covered, but our PhD indicated she was not comfortable using that as a dx, as she is not treating their Obesity.
Wondering what others are doing?

Thanks!
 
I did not look at the LCD with the ICD10 dx codes, so I dont know if they allow for E66.2 and E66.3.

If the encounter is to pass a psychological exam for bariatric surgery, then the Dr is treating the obesity as the patient has no other reason to present themselves. If there is a disqualifying dx, then that dx should be used for the encounter. If there is a psychological condition than can be treated prior to the surgery, then that dx should be used, but if the patient has no psychological problems and is ok for surgery, then the obesity dx is ok. I would follow it with the Z code for the BMI as well. Just make sure that it is notated that the purpose of the encounter was an evaluation for bariatric surgery.
 
over eating

My behavioral health provider lieks to use F50.9 which is unspecified eating disorder. This is not covered in the LCD (L35101). However, F50.89 is (other specified eating disorder). Most patients either over eat or are stress/emotional eaters which is documented and therefore specified so this is the code I use.
 
96130

Hello fellow coders,


I was reading through the posts on this topic and I am in the same boat as you guys when it comes to pre-surgery eval. by a Psychologist. I have some in my group I code for that do pre-surgery for bariatric, liver, heart and kidney and I am looking at 96130 and possibly 96136 as they also perform several screenings on the pts. According to AAPC Coder there are only a hand full of Dxs. that can be used with these codes with one that could work being Z13.89 followed by Dx. given.
Have any of you looked into these CPT codes to use for this type of services? Appreciate your input.
 
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I am currently tasked with the same question - the visit is not necessarily a preop surgical clearance - it's a psychological evaluation to determine if the patient is mentally capable of making an informed consent? Are they able to consider the risks involved, when explained, and use that information to make the decision to undergo surgery? For that - I have looked and scoured the internet, and am only able to come up with 96150 and 96151- maybe 96152
 
90791 was also a consideration - but that service is to diagnose, that isn't the case with the bariatric surgery clearances - the provider is not diagnosing, they are determining the patients mental capacity to give informed consent and 90791 just doesn't seem appropriate.
 
When I code out the psych exam/testing for bariatrics I use 90791, 96136 and 96137 for the testing and scoring (of at least two tests) and 96130 and 96131 for evaluation services. The doctors use the codes they determine are best, most often an obesity code or a mental health code if there is one.
 
HELP!! My clinic is using a psychologist to evaluate patients wanting to go through with bariatric surgery for weight loss. I keep reading how all the charges should be dropped on the return visit when the patient comes in to receive feedback from all the tests completed during the first visit. My question is how should the first visit be coded? Regular office visit E/M? Or something else?

Here's how it works:

Patient presents to clinic for evaluation with psychologist to prepare for bariatric surgery. At least 60 min is used completing MMPI, PHQ9, MBMD, AUDIT, DAST, GAD7 and a few other tests.
This same patient then returns to clinic (the next day/week/month) to review results and receive feedback from the psychologist in preparation for the surgery.

I'm thinking the first visit should be coded with one of the following:
1. Regular E/M visit + one of the DX codes mentioned above?
- OR -
2. 96136 - Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes
3. 96137 - each additional 30 min as documentation supports

Then for the follow up visit to review and receive feedback I think the coding should be as follows:
1. 96130 - Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour
2. 96131 - each additional hour as documentation supports

It turns out when the psychologists use the 90791 (psychiatric diagnostic evaluation) their numbers are being tracked in the wrong department, which is a problem and the reason for my confusion.

THANK YOU!!
 
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magdalena.iordan@yahoo.com said:
96130

Hello fellow coders,


I was reading through the posts on this topic and I am in the same boat as you guys when it comes to pre-surgery eval. by a Psychologist. I have some in my group I code for that do pre-surgery for bariatric, liver, heart and kidney and I am looking at 96130 and possibly 96136 as they also perform several screenings on the pts. According to AAPC Coder there are only a hand full of Dxs. that can be used with these codes with one that could work being Z13.89 followed by Dx. given.
Have any of you looked into these CPT codes to use for this type of services? Appreciate your input.
Click to expand...
Hello, I used to code the same codes for pre-surgery eval. by a Psychologist. 90791 with 96130 and z01.818
 
Hello, I have some Qs and input on this topic
I work in a Behavioral Health clinic.
We are trying to bill for a pt that needs bariatric clearance for surgery.
The initial eval was billed with 90791 and Z018.18 - which was denied as the Z codes are not covered as a primary diagnosis.
We are seeking an alternative code for the claim to be billed, however the patient present with no psychology problems.
I asked the provider, "well, what initiated the patient's need for surgery in the first place? Is it the worry of being overweight on the arms?"
While this was not documented, the provider states perhaps yes. So this is a notation for self an others for the providers to really engage in asking the patient these questions (especially in a behavioral health practice) so they can be diagnosed and reimbursed properly.
 
Correct coding expects us to assign the procedure and diagnosis that most accurately represents why the patient was seen and for what reason. Tweaking the codes specifically for payment (and I get it.....you want to get paid) is not the way to do this compliantly. Get an ABN if you think you may not get paid; make this patient responsibility.
Z13.30 is the code for screening for mental/behavioral health disorders. It can be reported as a primary code--but some payers don't want to see it, even though it meets the criteria for a primary diagnosis. Without symptoms or meeting the DSM criteria for an eating disorder or other condition, you shouldn't report those codes. You're doing a diagnostic interview (90791) to screen if the patient has any behavioral health symptoms, conditions or emotional barriers that would disqualify them from undergoing bariatric surgery or cause them to be unsuccessful in the post-surgical setting. Asking those questions in order to elicit an answer from the patient that will give the provider a diagnosable condition is key. If no such symptom or problem shows up, then you have to report the screening code. Before you see the patient, make sure they understand that their insurance may not cover psychiatric care if there is no symptom or condition and that you can't make one up.
 
Pam Warren said:
Correct coding expects us to assign the procedure and diagnosis that most accurately represents why the patient was seen and for what reason. Tweaking the codes specifically for payment (and I get it.....you want to get paid) is not the way to do this compliantly. Get an ABN if you think you may not get paid; make this patient responsibility.
Z13.30 is the code for screening for mental/behavioral health disorders. It can be reported as a primary code--but some payers don't want to see it, even though it meets the criteria for a primary diagnosis. Without symptoms or meeting the DSM criteria for an eating disorder or other condition, you shouldn't report those codes. You're doing a diagnostic interview (90791) to screen if the patient has any behavioral health symptoms, conditions or emotional barriers that would disqualify them from undergoing bariatric surgery or cause them to be unsuccessful in the post-surgical setting. Asking those questions in order to elicit an answer from the patient that will give the provider a diagnosable condition is key. If no such symptom or problem shows up, then you have to report the screening code. Before you see the patient, make sure they understand that their insurance may not cover psychiatric care if there is no symptom or condition and that you can't make one up.
Click to expand...
Pam, thank you so much for this prompt response! Your insight is most helpful and was the exact sort of information I was looking for. I appreciate that!!

I will be sure to discuss the information with my team.
I will suggest the Z13.30 be used as the primary.
I would advise to use the patient's BMI as secondary, but I am not too sure that was documented in our clinic.

Again, I REALLY appreciate you, Have a Happy New Year! :)
 
ElleK said:
@Pam,
Question...
Should we code Z13.3 and then E66.01 for obesity?
Click to expand...
If you code E66 and Z68 per % pt weighs in, then dx Z72.4 Using dx Z13 .3 means mental health DO provider needs to document some beh. health dx too. Why not find out if the patient has Depression dx F32 or F33 or R63.2 or F50 Eating DO or block R45 or F41 Anxiety or some type mental health problem related to patient's being overweight? That be better linked with Z13.3 There are some meds make you overweight if have chronic condition or pt. being stressed.
Provider might want to do better documentation
Lady T
 
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