psychological testing

[Psych Moon]

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Hi, I am a health psychologist at a very busy pain clinic and I am responsible for evaluating patients for candidacy for spinal cord stimulation, I am planning to start administering the Millon Behavioral Medicine Diagnostic (MBMD). The practice only allows me 90 min for this type of assements and as I have been researching how to integrate the Millon into my practice, I have a few questions:

1. What type of CPT code should I use to bill for the Millon?
2. Is 90 min enough?
2. Do I have to verbally disucss the results of the Millon in a separate session and bill for this as well? or writen report is enough? If a separate session is required how should I bill for this then?

Given that I am in very bussy practice we don't count with the time to necesarly do the Millon over two separate sessions. I guess I wan to know what others are realistically doing out there.

I truly appreciate you taking the time to read this message, and I would be grateful for any additional insights or recommendations.
Thank you

 

[R. Matey]

PSA, this poster has literally copied and pasted the same post multiple times on the psychiatry board.

 

[docloufan]

You have to give 2 or more tests to bill the Psychological Testing codes. I would talk to your practice about the limited time they are giving you. That said, the procedure itself is hit or miss and its not really clear how valuable or impactful the pscyh eval is to most cases.

 

[Therapist4Chnge]

You have to give 2 or more tests to bill the Psychological Testing codes. I would talk to your practice about the limited time they are giving you. That said, the procedure itself is hit or miss and its not really clear how valuable or impactful the pscyh eval is to most cases.

Citations?

I do pre-surg evals as part of my practice and they are actually one of the most useful evals psych can offer our surgical colleagues. The research is pretty clear about post-op outcomes, and they don’t support your above statement.

Traditional psych testing to clarify a psych diagnosis….probably less useful in most cases, at least in regard to time/$ and value to the case. I agree w the limited value above a good clinical interview in most instances.

 

[Therapist4Chnge]

From a practical standpoint, you can design a battery of primarily self-report measures that when combined with a good intake interview and chart review that can produce not only a useful report, but billed in a way that can work and not be a time suck. I’m more of a -2RF or BHI-2 fan, but the MBMD works too bc doing it computer-based gives you similar flexibility.

One reason I like pre-surg evals are bc they do have good research support, are often required before a surgeon will operate, and they usually get covered. I don’t take commercial insurances, but last I checked pre-surg was one of the more reliable testing niches.

 

[cara susanna]

We do pre-surgical evals and we don't give feedback sessions. We give the report and recommendations to the surgical team.

Is there any way to advocate for more time to do these assessments? It's not something you want to rush.

 

[docloufan]

Citations?

I do pre-surg evals as part of my practice and they are actually one of the most useful evals psych can offer our surgical colleagues. The research is pretty clear about post-op outcomes, and they don’t support your above statement.

Traditional psych testing to clarify a psych diagnosis….probably less useful in most cases, at least in regard to time/$ and value to the case. I agree w the limited value above a good clinical interview in most instances.

No, not off hand, but I did read a paper earlier this year about the procedure and outcomes. Large N stuff. Wasn't impressive. Case by case basis, obviously. Didn't really address the psych eval part directly, but I have to wonder about the lack of mentioning also speaks to its value, overall?

Its often a clause in the insurance coverage. I think the clinical usefulness and determination aspects have been a bit overblown.

 

[Therapist4Chnge]

We do pre-surgical evals and we don't give feedback sessions. We give the report and recommendations to the surgical team.

Is there any way to advocate for more time to do these assessments? It's not something you want to rush.

I would think they'd also want that revenue. I'd argue that there is the INTAKE (day 1), TESTING (day 2), and FEEDBACK (day 3, could be optional, but I don't like skipping). I usually do a 30min (though sometimes 45-55+ min) feedback session, it depends on if I'm going to recommend further intervention before/after the assessment. I can see some possible pushback against '1 and done' or '2 and done', but billing-wise it makes the most sense to split over 3 appts. I have my assistance schedule all 3 appt up front and make sure the referring provider knows that is how we do it. Doing it all in one day can be a long day for medically complicated patients and/or patients with significant pain problems.

It can be billed and completed in 1 day, but it's less revenue bc of codes available, especially since additional testing codes on the same day as a 90791 is likely a non-starter for most insurances. If I'm going to do a formal assessment, the last thing I want to do is give it away for free because most insurances won't allow another billing code on the same day as a 90791 because they consider any assessment done on that day to be part of the 90791 coding. If the personal already had an intake (90791), then testing in 1 day is fine, but a brand new patient I'd want a regular intake bc I would go more in-depth in the clinical interview than if I was just doing testing for an existing patient. Using a tech really knocks down the reimbursement value and isn't a good use of their time. I rarely used a tech for pre-surg testing, unless I was slammed, then the money was a secondary factor with time/completion date being more pressing.

I know some dementia clinics that do 1 day (intake + testing) with FB being at the end of the day or a week later, but the economics of that are less than ideal because the insurer could likely deny the FB billing. A switch to strictly H&B codes (which I'd argue really isn't a fit for pre-surg or dementia) kills the value/RVUs and makes that a poor choice. High volume and templated I guess that model might be easier to do, but I've never wanted a high-volume practice. For pre-surg evals, it's not rocket surgery, so a templated out report is easy enough, though since you get paid to write, from a billing perspective I'd still want to take the time and do it right w/o cutting corners.

 

[PsyDr]

No, not off hand, but I did read a paper earlier this year about the procedure and outcomes. Large N stuff. Wasn't impressive. Case by case basis, obviously. Didn't really address the psych eval part directly, but I have to wonder about the lack of mentioning also speaks to its value, overall?

It’s often a clause in the insurance coverage. I think the clinical usefulness and determination aspects have been a bit overblown.

So your premise is that the insurance company requires an additional $1k service, for a procedure that costs them $2k because????

Help me make sense of that.

 

[docloufan]

So your premise is that the insurance company requires an additional $1k service, for a procedure that costs them $2k because????

Help me make sense of that.

Oh yea. 100%. That's the whole thing of what I'm saying. Poor ROI, overall. Terrible stuff.

 

[PsyDr]

Oh yea. 100%. That's the whole thing of what I'm saying. Poor ROI, overall. Terrible stuff.

Cool. Can I get second author on this article?

 

[WisNeuro]

The evaluations are very useful, if there are adequate resources for follow-up. We know that there are many things that can be identified in the presurgical eval that predict outcomes. And, if we put perisurgical supports in place, you can maximize outcomes.

So, if you're just doing a presurgical eval to check a box and have no real infrastructure or desire to do anything with the evals, they yeah, the ROI sucks. If you plan on using them as intended and have the infrastructure to follow-up with them, the ROI is significant.

 

[docloufan]

Cool. Can I get second author on this article?

Second author??? What exactly do you think is happening here?

Look man, if you have something to say, just say it. No reason to invoke a whole "journal club" thing.

 

[PsyDr]

Second author??? What exactly do you think is happening here?

Look man, if you have something to say to me, just say it.

I’m saying there is a body of literature that firmly established something something for over 30 years, to a degree that led to acceptance by medical device companies, insurance companies, and surgical societies treatment guidelines.

Then you’re saying “nu uh”, with zero proof.

If you’re important enough that your unsubstantiated opinion obviates all scientific publishing, I want in. If you’re just saying “I misread some article, and the rules from a $22B division of a medical device company doesn’t apply, because I said so”… let me know.

 

[docloufan]

I’m saying there is a body of literature that firmly established something something for over 30 years, to a degree that led to acceptance by medical device companies, insurance companies, and surgical societies treatment guidelines.

Then you’re saying “nu uh”, with zero proof.

If you’re important enough that your unsubstantiated opinion obviates all scientific publishing, I want in. If you’re just saying “I misread some article, and the rules from a $22B division of a medical device company doesn’t apply, because I said so”… let me know.

Piece of advice. Just say what you want to say. No mystery is needed.

But yea, shady evidence all around for what I said before.

 

[PsyDr]

Dude. Just say what you want to say. Geez. No mystery needed.

Back up your point, at a level consistent with 30 years of research, or admit you’re wrong.

 

[docloufan]

Back up your point, at a level consistent with 30 years of research, or admit you’re wrong.

At "a level consistent." Again, what exactly do you think is happening here?

 

[psych.meout]

Piece of advice. Just say what you want to say. No mystery is needed.

But yea, shady evidence all around for what I said before.

Uh.....

Again, No.

...

Piece of advice. Just say what you want to say. No mystery is needed.

But yea, shady evidence all around for what I said before. And never trust... "the man." I am not important, and neither are you. And...."Medical Device Companies"? Get real.

That slap fight aside, what specifically are you criticizing in this literature? What specific issues are you alluding to?

Is it poor quality comparison groups (e.g., waitlist control with no treatment instead of sham treatments)? Is it a blinding issue? Is it a measurement and/or outcome variable concern (e.g., VAS vs PDI vs Oswestry)? Are there substantial publication bias issues due to COI and funding conflict?

That you're eschewing every question and opportunity to provide more detail makes this seem like the medical device version of anti-vax histeria.

 

[docloufan]

Uh.....


...

That slap fight aside, what specifically are you criticizing in this literature? What specific issues are you alluding to?

Is it poor quality comparison groups (e.g., waitlist control with no treatment instead of sham treatments)? Is it a blinding issue? Is it a measurement and/or outcome variable concern (e.g., VAS vs PDI vs Oswestry)? Are there substantial publication bias issues due to COI and funding conflict?

That you're eschewing every question and opportunity to provide more detail makes this seem like the medical device version of anti-vax histeria.

100% skeptical of anything that comes from a 'medical device" company.

And again, this all stared with the premise of a surgical implant to help chronic pain. What do we think about this?

 

[PsyDr]

At "a level consistent." Again, what exactly do you think is happening here?

I think you are asking deflecting questions, anytime you are asked to support your assertion.

Why do you think you are doing that?

 

[docloufan]

I think anytime you are asked to support your assertion, you are asking deflecting questions.

Why do you think you are doing that?

Do you people think this is a journal club? I've told you what I think is most correct. That's the end of it.

 

[PsyDr]

Do you people think this is a journal club? I've told you what I think is most correct. That's the end of it.

Do you often use "Because I said so" in arguments?

 

[WisNeuro]

Do you people think this is a journal club? I've told you what I think is most correct. That's the end of it.

I mean, you made a claim about a fairly significant niche setting in the field, based off research that you supposedly read. People asked about the source of your "information" about the claim. It wasn't exactly an unreasonable request to make. At this point it seems much more likely that it's just your personal opinion for which you lied about actually having read something about.

 

[docloufan]

I mean, you made a claim about a fairly significant niche setting in the field, based off research that you supposedly read. People asked about the source of your "information" about the claim. It wasn't exactly an unreasonable request to make. At this point it seems much more likely that it's just your personal opinion for which you lied about actually having read something about.

Na. I read it. Lets move on now.

 

[docloufan]

Do you often use "Because I said so" in arguments?

of course. most people do.

 

[PsyDr]

Na. I read it. Lets move on now.

I heard you didn't read it at all, and made it all up. Let's move on now.

 

[docloufan]

I heard you didn't read it at all, and made it all up. Let's move on now.

its all over.

 

[PsyDr]

its all over.

Naw. You told me it wasn't.

 

[WisNeuro]

Naw. You told me it wasn't.

I read somewhere that it wasn't.

 

[PsyDr]

I read somewhere that it wasn't.

 

[docloufan]

now reading books is bad? you people are unbelievable.

 

[PsyDr]

now reading books is bad? you people are unbelievable.

what exactly do you think is happening here?

 

[Therapist4Chnge]

I read somewhere that it wasn't.

I don't know how to put this but I'm kind of a big deal. People know me.I'm very important. I have many leather-bound books and my home smells of rich mahogany.

RICH MAHOGANY Wis…..that’s a wood. Real wood. Let’s move on now.

 

[AcronymAllergy]

Mod Note: Okay all, let's try to steer back to professional tone and discussion. Thanks.

 

[msc545]

PSA, this poster has literally copied and pasted the same post multiple times on the psychiatry board.

That suggests that the poster doesn't know too much about Psychiatrists, who in turn mostly don't know much about Psychological testing.