|
38.3.2 Outpatient Behavioral Health Services
38.3.2.1 Psychiatric Diagnostic Interviews
Psychiatric diagnostic interview examination (1-90801) and interactive psychiatric diagnostic interview examination (1-90802) are limited to once per day per client, any provider, regardless of the number of professionals involved in the interview, and once per year per provider (same provider) in any setting.
An interactive interview (procedure code 1-90802) may be covered to the extent it is medically necessary. Examples of medical necessity include, but are not limited to clients whose ability to communicate is impaired by an expressive or receptive language impairment from various causes, such as conductive or sensorineural hearing loss, deaf mutism, or aphasia.
A diagnostic interview may be incorporated into an evaluation and management (E/M) service provided the required elements of the E/M service are fulfilled.
A diagnostic interview examination (procedure codes 1-90801, 1-90802) is denied as part of any E/M service when billed for the same date of service by the same provider.
Documentation for diagnostic interview examinations must include:
• Reason for referral/presenting problem.
•Prior history, including prior treatment.
•Other pertinent medical, social, and family history.
•Clinical observations and mental status examinations.
•Complete Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition, Text Revision (DSM-IV-TR) diagnosis.
•Recommendations, including expected long term and short term benefits.
•For the interactive diagnostic interview (procedure code 1-90802), the medical record must indicate the adaptations utilized in the session and the rationale for employing these interactive techniques.
|
