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As part of the Patients over Paperwork initiative, beginning in March the Centers for Medicare & Medicaid Services (CMS) will streamline its survey and certification process for psychiatric hospitals. Cutting the Red Tape Since launching the Patients over Paperwork initiative in fall 2017, CMS has streamlined regulations to reduce clerical and administrative burdens that weigh […]
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Would I consider the PRTF to be a nursing facility?
Would this be considered a consultation because this physician is providing medical care not related to their mental health? Or would I code as regular E/M for the location type?
Any help is appreciated!
Also, if a nurse is performing the injection is 99211 used alone?
Would insurances reimburse for an E/M with modifier -25 in addition to 96372 if a nurse is performing the injection? Is it required for a physician to be present?
Also, if blood is being drawn to be sent to an outside lab is it possible to be reimbursed for 36415 or is this considered inclusive of an E/M code? And can this be done by a nurse?
Are there any modifiers required for 36415 in this situation?
90791 Psychiatric diagnostic evaluation
Providers currently bill 90791 for an initial intake appointment. This is when the providers are gathering information from the parents regarding their concerns. Outside of the appointment, the parents complete questionnaires and measures to help the psychologists determine what diagnostic testing may be appropriate.
If testing is warranted, they then bill 96101 for the testing/evaluation and the subsequent time it takes to analyze, write the reports, etc. An authorization for this service is often required and they may request up to 8 hours for it.
96101 Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, eg, MMPI, Rorschach, WAIS), per hour of the psychologists or physicians time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report
Our question is since the 90791 is broad, what would keep them from being able to bill 90791 for the testing and then 96101 for the time it takes to interpret the results and write the report?
Can anyone offer any insight??
Bypassing the standard notice of proposed rulemaking and public comment period, the Centers for Medicare & Medicaid Services (CMS) issued, July 28, a final notice of 2017 Medicare payment and policy changes for inpatient psychiatric facilities. CMS can waive notice and comment if they have good reason. “We find it unnecessary to undertake notice and […]
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