Coding Question

[285963]

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Let's say I admitted a patient to the hospital, followed them through their hospital course and then discharged them to start partial hospital (PHP).
If I am then also the admitting doctor for the PHP, and I'm seeing the patient for the initial intake at the PHP, what billing code would you use?
90792? 99203/4/5? 99213/4/5?
My concern with the first two are that insurance could say a PDI (90792) or new patient E&M (99203/4/5) are not medically necessary, because I know the patient from their inpatient stay and I'm not really doing a new evaluation.

 

[wolfvgang22]

99214 for me. Somebody tell me why I'm wrong.

 

[splik]

You can use 90792 or an outpatient follow up code (e.g. 99214/5). You can't use new patient codes (e.g. 99204/5) because it's not a new patient. 90792 is for a psychiatric diagnostic evaluation w/ medical services, and thus is NOT reserved only for new patients, and can be used more than once. For example, child psychiatrists may see a child and patient for evaluation over 2 visits and bill 90792 for both visits; or if you see a "frequent flier" in the ER you can bill 90792 each time. Because prior authorization is required for PHP, and because an initial psychiatric evaluation is required to justify PHP, 90792 is the most appropriate code in this situation. If you werent the same psychiatrist for inpatient, you could also use the initial outpatient codes (i.e. 99205)

 

[285963]

This is great. Thanks for the detailed answer!