I am trying to figure out a number of different issues for Crisis services. My practice has a walk in practice for clients in Crisis and also operates a Mobile Crisis team where they meet with members of the public who are identified as being in crisis.

Initially, I am clear on this much of the progression.

1) Client encounters a therapist while in a state of crisis.
2) Crisis therapists bill for the encounter based on time (90839 for the first 60 minutes and 90840 1 unit for each 30 minutes following)

We rely on diagnosis and observations and subjective comments from the client to form the documentary basis for medical necessity. Is the client’s need immediate, is the client in a highly risky position, etc.

After the initial visit is complete, here is where I find trouble. My crisis therapists are being asked to follow up with members of the public that they encounter. They are trying to bill 90839/90840 for these follow up encounters. The encounter for follow up is often a visit which is scheduled on the therapist’s calendar and my therapists are often beginning the note with ‘client arrived on time for session…’

It’s not always the same, for each client. I can certainly understand that for some members of the public a crisis can be on-going. I am specifically concerned that for some of these clients, the criteria being used for follow up visits is aged. That age could be 24 hours old or it could be 4-7 days old. Is the medical necessity, which was applied as a basis for Crisis Intervention a day ago, still valid? How about a week ago? At what point does 90839 no longer apply for a client whose initial encounter was during crisis?

Does a crisis client ever stop being a crisis client?

Thanks!