Wiki Psychiatric Billing

[dsheets07]

I am new to psychiatric billing. We have a new group of psychiatrist which have joined our multi-specialty practice and I need to understand the national standards. Do most psychiatrist bill regular E/M service codes in the inpatient/outpatient/clinical setting or should they use the psychiatric service codes 90801-90899 for their patient face-to-face visits. I spoke with a psychiatric auditor today who stated she sees them bill both E/M and/or the psychiatric service codes depending on their level of documentation. If their documentation fits the guidelines for E/M they bill E/M etc. She is sending me templates she uses for auditing both types of services but I would like some additional opinions.

Medical providers are not allowed to bill psychiatric service codes by CMS and the services the psychiatrist are providing are all mental health related with medication treatment in some cases but there are psychiatric service codes which also fit this description. Any advice anyone has will be greatly appreciated. I'm old coder (30+ years) learning new tricks!

 

[lynncpc]

Psychiatry Services

Most psychiatrist billed according to the service they provide. The first visit in most cases maybe a 90801. After the first visit, if psycotherapy is needed the the codes are based according to the time provide for the visit within the settings of outpatient vs inpatient.

Within the Psychiatry Section of CPT outlines the codes if medical evaluation and managment services were provided during the psychotherapy session.

If the psychiatrist, refers the patient to an social worker and/or psychologist. Then you must append the apporiate modifer for the social worker (modifier AJ) and (modifier AH) for the psychologist. If medication is needed the the correct code should be 90862.

Also, you will need to check with the mental health carrier in regards to what is acceptable per their fee schedule.