Forum - Questions & Answers
90801 and 99215 billing together?
Can I bill for a 90801 and a 99215 on the same day and if so how?
why would you do it?
Are there two clinicians?
Is it one clinician trying to bill for both?
Medical necessity
You will not get both. Code 90801 is an extensive psychiatric evaluation and is
described as the elicitation of a complete history, establishment of tentative diagnosis, and an evaluation of the patient's ability and willingness to work to solve the patient's mental problem.
90801 and 99215 billing together?
One provider is billing for both. What if the patient comes in for a mental exam and while the patient is seeing the doctor complains of her leg hurting? Can you not charge for both types of service?
90801 and 99215
99801 is done by a mental health professional or psychiatrist. 99215 is an E/M service, so only a psychiatrist could bill it. I can't imagine a circumstance in which the psychiatrist performed a diagnostic interview and also treated an unrelated medical problem.
90801 and 99215 billing together?
A 90801 can be billed by a medical doctor also and that is why I am trying to find out what they should do if the patient comes in for that but ends up with a regular medical problem also.
90801 and 99215
You raise a good point: there is nothing in the CPT book or in Medicare rules that prohibits an MD of any specialty from billing a psychiatric diagnostic interview. However, most private payers will deny it for a non-mental health provider: they'll say the MD isn't part of the behavioral health network.
If you find yourself in that situation, and the physician performed and documented both, you could try submitting, sending notes, appealing. I'm skeptical.
psy Interview
The psychiatric interview is an in-depth encounter. To bill an E/M during the same encounter is not permitted by Medicare CCI edits (0). if the medical problem is significant and acute it may require evaluation and the 90801 could be rescheduled. Documentation must show medical necessity and comments here do not have the record to give a final opinion.
