how to bill for multidisciplinary clinic w/ psychiatry?

[singasongofjoy]

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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? Obviously we can't ask a psychiatrist to join us until we can figure out how for them to bill. FWIW I'm in an AMC and there are a couple of psychiatrists who have expressed interest in doing this one day a week or e/o week if we can just figure this part out.

Thanks!

Note: cross-posted to the psychology forum also.

 

[clausewitz2]

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? Obviously we can't ask a psychiatrist to join us until we can figure out how for them to bill. FWIW I'm in an AMC and there are a couple of psychiatrists who have expressed interest in doing this one day a week or e/o week if we can just figure this part out.

Thanks!

Note: cross-posted to the psychology forum also.

In my neck of the woods for psychiatrists 99203-99205 pays much better than 90791 or 90792 so almost everyone uses the former to bill for an evaluation of a new patient. That way, different code, different specialty of provider billing, much less likely to get kicked back to you.

Looking around the Internet this seems to be the standard advice. Some payers apparently are cool with paying for a 90791 AND a 90792 on the same day but not all.

 

[Sushirolls]

I believe some medicaid insurance might have rules that you can't see a mental health person of any type on same day and bill for it. Only one can submit a bill. It might also be related to private insurance too, if both bills from therapist & Psychiatrist are coming from the same business (type II NPI number). But if the bills are coming from different NPI numbers (i.e. the Psychiatrist is an independent practice) then its likely to not be an issue.

Verify with the insurance companies. I may have just made all the above up and there's no truth to it.

Ultimately, calling up the insurance companies and presenting the hypotheticals are your best bet to get an answer. Try to get it in writing.

 

[splik]

Psychiatrists do not (or at least should not use 90791). This is meant for non-medical mental health clinicians. they can use 90792 but as clauswitz has pointed out above, for this sort of thing it typically works out much better to use 99205 (an E&M code). Whenever you are doing some a little specialized and out of the ordinary you want to get prior authorization to prevent nasty surprises. Someone should contact the patient's insurance ahead of time to verify they will pay for this.

as an aside, the same clinician can use 90791/2 more than once as long as it is justified. This is not uncommon in child psychiatry where visits for the initial intake may be spread over 2 sessions to allow enough time for assessment of patient and gathering information from family.

 

[dl2dp2]

Always have psychiatrists bill for MD-specific codes. They reimburse better, and it's harder for insurance to reject because of federal parity laws.