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Has anyone had luck getting reimbursed for Bariatric Assessments when there is no dx?

Tina B 3 years ago in Billing/Electronic Modules updated 3 years ago 2

I usually do from 50-100 bariatric assessments per year,and rarely have reimbursement problems. The most common problem is when I forget to request prior authorization for companies that require that for 96101-96103. 


I think that the problem of not being reimbursed would depend upon what code you are using.  I usually complete a diagnostic assessment and use the info to decide what testing code to use.  It should not be a problem to be paid for 90791, as you bill for "what you are looking for," and it is always necessary to rule out psychiatric diagnoses.  


If a bariatric patient does not have a psychiatric diagnosis as a result of the DA, then billing for 96101 would be problematic.  On the other hand, if the DA identifies one, or some, rule-out diagnoses for psychiatric conditions, then it would be possible to use those diagnoses.  On the other hand, if the the patient has no history of receiving any mental health services, denies current psychiatric symptoms, and shows no behavioral indications of symptoms during the interview, testing with 96101 would probably not be medically necessary as far as insurance companies are concerned. 


For these patients, Health and Behavioral Assessment (96150) would be ideal - but you must have a medical, as opposed to psychiatric, diagnosis - such as E66.01.  You may also have to provide the NPI of the referring MD (bariatric surgeon, in this case) but that is readily available online. 

Thank you so much for this information Richard. This clears up a lot.

 I think it is the code we are using. We specialize in Eating Disorders and have a contract for a 2-hr ED bundled intake that we have been using.