Billing code for bariatric surgery clearance?

[nrmp]

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If patient has no psychiatric history, no current symptoms then which diagnosis would you choose to get paid from all the insurances? Thank you

 

[Sushirolls]

This is one of the reasons why I lament the current infrastructure of the health system and that we aren't strictly a time based billing like law.

 

[nrmp]

Agree but still looking for an answer

 

[cara susanna]

You can't bill for obesity? I work in the VA and that's what we do.

 

[romanticscience]

I don't know. The most benign thing I can think of would be (F54), "Psychological factors affecting other medical conditions."

 

[Sushirolls]

Agree but still looking for an answer

Try 3:
obesity
Psychological factors affecting other medical conditions
and see if there is some ICD 10/11 code out there that says pre-surgical evaluation.

Thinking out loud, I suppose you could justify a peri-anesthesia operative code that they might use (check with anesthesiology folks)? Its technically part of the perioperative care. You aren't managing airway or HTN risk, but managing mental health risk?

 

[deleted343839]

I usually bill x units of 96150 and use the applicable morbid obesity diagnosis. Reimbursement is pretty terrible but with 96150 you don't need a psych dx. I'm not sure if physicians are able to use these codes, however.

Most payers will reimburse for 90791. There is an ICD code specific to psych evals before weight loss surgery, but off hand I don't remember what it is. I've heard that some people also use F54 or use an unspecified eating disorder dx.

 

[Armadillos]

Full disclosure, my EMR does most my billing thinking for me so I’m not as up on the nuances, but why couldn’t you just bill the initial intake psychiatric eval/Med services code regardless of diagnosis?

 

[splik]

You can't bill for obesity? I work in the VA and that's what we do.

well you dont bill at the VA....
you can do obesity but if they have a behavioral health carveout then you need to have an F code
otherwise I just use Z01.818 (pre-operative exam) and Z03.89 (observation for suspected mental condition)
if they have shîtty insurance it won't fly. But remember that the insurance requires the psychological evaluation.
Typically I insist that surgery pay me for these out of their own funds and they can worry about billing. They can get prior authorization for the eval if they want to bill for it (typically you need to get prior auth in order to ensure reimbursement). IMHO they make a huge amount from doing these procedures, need a psych eval, and thus they can pay me for it.

Also, there is not such a thing as psych "clearance". We are not security. It is best not to think of your job in that way or to document as you are "clearing" the surgery for a procedure or you may find yourself liable for the inevitable complications. Instead, I might put something like "There are no absolute contraindications to ___ from a psychosocial perspective. In order to further optimize her candidacy for this procedure I recommend the following:" (there is almost always something to recommend to, even if the pt doesnt have a mental illness.

The only exception is if the indication for surgery is psychiatric (e.g. BSO for PMDD or DBS for OCD etc) - in that case I will highlight where the intervention is warranted, but even then discuss potential risks etc and never equivocally say pt should have the procedure etc.

 

[dl2dp2]

Use your usual billing code with a billable ICD10.

Remember, claim processors are not very ... flexible. Any unusual code triggers a reflexive denial.

 

[nrmp]

well you dont bill at the VA....
you can do obesity but if they have a behavioral health carveout then you need to have an F code
otherwise I just use Z01.818 (pre-operative exam) and Z03.89 (observation for suspected mental condition)
if they have shîtty insurance it won't fly. But remember that the insurance requires the psychological evaluation.
Typically I insist that surgery pay me for these out of their own funds and they can worry about billing. They can get prior authorization for the eval if they want to bill for it (typically you need to get prior auth in order to ensure reimbursement). IMHO they make a huge amount from doing these procedures, need a psych eval, and thus they can pay me for it.

Also, there is not such a thing as psych "clearance". We are not security. It is best not to think of your job in that way or to document as you are "clearing" the surgery for a procedure or you may find yourself liable for the inevitable complications. Instead, I might put something like "There are no absolute contraindications to ___ from a psychosocial perspective. In order to further optimize her candidacy for this procedure I recommend the following:" (there is almost always something to recommend to, even if the pt doesnt have a mental illness.

The only exception is if the indication for surgery is psychiatric (e.g. BSO for PMDD or DBS for OCD etc) - in that case I will highlight where the intervention is warranted, but even then discuss potential risks etc and never equivocally say pt should have the procedure etc.

Like your recommendation on clearance but not saying "clearance". I tried above Z01 code for pre-operative exam and claim was denied. I believe most insurance expect F code (also probably not the unspecified ones). I guess best thing to do with these eval is charge cash upfront and not worry about billing or not do those evals taking extra liability for nothing.

 

[Armadillos]

Not a billing expert, but why can’t you just bill your normal 90792 intake? Or you needing to get paid for more than that?

 

[TexasPhysician]

Not a billing expert, but why can’t you just bill your normal 90792 intake? Or you needing to get paid for more than that?

You need a diagnosis code to bill 90792.

 

[Armadillos]

You need a diagnosis code to bill 90792.

Morbid obesity?

 

[TexasPhysician]

Morbid obesity?

Generally not enough for insurance companies as it’s not a psych diagnosis.

 

[FlowRate]

Also, there is not such a thing as psych "clearance".

Not just this, but also how we were taught on IM and on cards. Nobody "clears" a patient for surgery, they optimize patients for surgery (or say why it's a really bad idea but here's how to try and tune them up if you still want to go ahead.)

 

[AD04]

What kind psychiatrists usually do these evaluations? I personally learned from a general psychiatrist but that is N of 1.

 

[WisNeuro]

It's all done by psychologists here. Though, some insurances are balking at paying for any reimbursement for testing instruments (e.g., MMPI and the like) so it may boil down to a clinical interview alone at some point. They don't tend to pay well, and I don't see that changing.

 

[Merovinge]

Ours are done by LCSW's, no one else wants to do them