DA Billing Question

Heather Wadie 5 years ago in Billing/Electronic Modules updated by Richard Sethre, Psy D , L P. 5 years ago 4

We have a client that was being seen for a diagnostic assessment, but the client walked out after 20 minutes. Has anyone else had a situation like this and if so, how did you bill? It doesn’t seem to fit the DA requirements, but maybe it can be billed as an individual psychotherapy session?

Not for 20 minutes; too short.

Yes, you can--only 16+ minutes is needed to bill for a 30 minute session, but what code would you use for the diagnosis?

Don't know if this is a MA client, but there is a list of R45 codes they have approved for initial sessions:

  • R45.0 Nervousness
  • R45.1 Restlessness and agitation
  • R45.2 Unhappiness
  • R45.3 Demoralization and apathy
  • R45.4 Irritability and anger
  • R45.5 Hostility
  • R45.6 Violent behavior
  • R45.7 State of emotional shock and stress, unspecified
  • R45.8 Other symptoms and signs involving emotional state
  • R45.82 Worries
  • R45.83 Excessive crying of child, adolescent or adult
  • R45.84 Anhedonia
  • R45.85 Homicidal and suicidal ideations
  • R45.851 Suicidal ideations
  • R45.86 Emotional lability
  • R45.87 Impulsiveness
  • R45.89 Other symptoms and signs involving emotional state

90791 is a"unit-based" code, not a "time-based code," so there are no time requirements.  You should, however, document the start and end time.  The 16 minute criteria applies to 90832, nor to 90791.In this case it seems pretty safe to bill for a 90791 - especially of the patient/client/person's behavior during the brief encounter provides info about a possible diagnosis and/or treatment issues.  If in doubt, talk to the insurance company's provider services staff.