help figuring out how to bill with multidisciplinary clinic w psychiatry

[singasongofjoy]

Hi wise minds,

Our autism clinic tends to get some of the more challenging cases from around our state and so we are trying to set up an interdisciplinary clinic to include a psychiatrist for some of our adolescent and adult folks. The difficulty we are having is figuring out billing. What we typically do for assessment now is have 90791 (mostly focused on developmental history) by a masters level clinician; a couple of weeks later the client comes in for the testing and feedback assuming it seems like a case where ASD is, in fact, a legitimate question (otherwise we refer them on to wherever seems better, e.g., psychiatry).

What we would hope to do would be to have a clinic one day a week with a psychiatrist, so we could see maybe 2 cases but e.g., while I was testing 1 client, the psychiatrist could be interviewing the other client and then swap, as we have a fair number of folks who ultimately seem to have a personality related dx, prodromal psychosis sx, etc. The question is how in the world to bill this with the psychiatrist. Could the psychiatrist also bill another 90791 for the same client/assessment, but on a different day? Is there some other code that can be used in situations like this?

(note: Will probably cross-post to psychiatry forum also)

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[FlowRate]

Someone who knows more about billing will probably get you a better answer but the psychiatrist will be able to bill 99203/4/5 which are E/M codes and therefore won't overlap with your diagnostic eval. I'm not sure whether 90791 and 90792 conflict but it does seem they would be overlapping in that the 90792 contains the work of 90791 and adds the medical component.

 

[deleted343839]

I assume the psychiatrist would have something else to do on these days other than see a couple of assessment cases? I'm not sure what the psychiatrist's role is other than as a consultant when there is evidence of other psych comorbidities or diagnostic uncertainty.

Psychiatrists don't bill 90791 - that's only for non-physicians. They use 90792. That issue aside, wouldn't you just bill for testing in the scenario you're describing? And the psychiatrist can bill for an E/M service?

Edited: the response above was posted right before I finished my response. Still unclear how this would be workable/sustainable from the perspective of psych unless they are also seeing other new patients and follow-ups on the same day.

 

[PsyDr]

100% answer:

The psychiatrist would bill E/M codes (i.e., 99213-99215). There's zero issue with that being used on the same day as other codes.