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Facility Component ED and Psych

Kelly Posted Tue 04th of December, 2018 10:56:36 AM
What CPT codes can the facility report in the Emergency Department when the patient is seen by a Psychologist/Psychiatrist? Can the facility report a low level ED E/M?
SuperCoder Answered Wed 05th of December, 2018 08:09:47 AM

Hi Kelly,

Kindly consider the following points :

  • Usually the ER codes would be billed by the ER physician who sees the patient in the ER. The psychiatrist who sees the patient in the ER is doing so as an outpatient consultation. He/she could use the E/M outpatient consult codes (99241-99245) or 90792. (If the patient has Medicare, you can't bill the consult codes, but can use the outpatient E/M new patient codes, 99201-99205, instead, or 90792). If both a social worker and a psychiatrist each did a complete evaluation on a patient, the social worker could bill a 90791 and the psychiatrist a 90792. That said. although you could code this way, it is likely that many payers would question why it was necessary for both clinicians to do an initial evaluation, and they may not be willing to reimburse for both. If the patient is admitted to the inpatient psychiatry service, the psychiatrist would use the initial hospital care E/M codes (99221-99225), which would cover both the consult and initial psychiatric evaluation.
  • CPT code 90792 can be considered, which can be used in any setting for a psychiatric diagnostic evaluation with medical services, or you can use one of the outpatient E/M codes that correspond to the complexity of the patient’s presentation. If the patient has not already been seen by another psychiatrist in your practice, you should use one of the new patient E/M codes; and if the patient is not new to your practice, you should use one of the established patient codes. Hope this helps!

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