Inpatient Psychiatric Evaluation and Management Codes

Document Sample
Inpatient Psychiatric Evaluation and Management Codes Powered By Docstoc
					ACCESS ALLIANCE OF MICHIGAN, 2-1-00; Revised 06-03-2008

                              Inpatient facility and/or Medical floor

Covered Services:
This service includes follow-up services provided by a psychiatrist as a result of the diagnostic
findings of a recent psychiatric assessment for the purposes of continuous evaluation and
management of the beneficiary. This service may involve an expanded problem-focused history,
an expanded problem-focused examination and medical decision-making of moderate
complexity. The psychiatric follow-up / subsequent care includes diagnostic assessment
reformulations, adjustments to medication or side-effects and other scope of practice revisions to
the consumer’s current health care plan.

Current AAM Procedure Code                                                 Unit Type (Current)
       Inpatient Psychiatric Follow-up – 99231 - 99233/99238                      Day

Eligibility Criteria and Service Priorities
1.       Beneficiary has been determined to be experiencing a mental illness, emotional disorder
         or developmental disability, reflected in a primary DSM IV or ICD-10 Diagnosis ( not
         including V Codes ) from a recent psychiatric assessment.

2.       Beneficiary displays active / remissive symptoms of psychopathology which are
         considered amenable to psychiatric medication or treatment:
         A.      Psychosis (includes both active symptoms: visual / auditory hallucinations,
                 delusional thought processes, self-talk and negative symptoms: a volition,
                 flatness of affect).
         B.      Bipolar (manic episodes, i.e. grandiosity, flight of ideas, ideas of reference,
                 pressured speech, sleep and appetite changes).
         C.      Depression ( single and recurrent episodes, i.e. depressed mood, tearfulness,
                 suicidal thoughts, hopelessness, sleep and appetite changes, lack of interest in
                 pleasurable activities, psychomotor agitation ).
         D.      Anxiety (generalized, panic, phobia).
         E.      Cognitive (memory loss, disorientation related to a demented illness ).
         F.      Any suspected psychotropic medication-induced disorder.
         G.      Behavioral disturbances indicating an approved Behavioral Management Plan.

Associated Outcomes

1.       Acute psychiatric symptoms decreased to a manageable level
2.       Psychotropic medications adjusted for maximum efficacy, i.e greatest benefit at lowest
         possible dosage.
3.       Health and Safety of self and others protected.
4.       Need for more restrictive interventions reduced.

Typical Service Utilization Pattern
Any beneficiary on a medical floor or inpatient facility determined to require psychiatric follow-up
and subsequent care is authorized to receive this service on a daily basis through the duration of
the acute admission. Note: This service may be covered as part of the acute inpatient per-diem
rate. Please refer to each provider’s individual contract to determine if this service is authorized

Threshold Value for Clinical Management Notification
Note: This service compliments units of SAC230. SAC 230 should be the service that is reported
to Clinical Management. Close attention should be made to ensure that SAC233 use does not
exceed the number of days of acute inpt. SAC233 may be used without SAC230 for those
consumers who have been determined to meet Medicare/Medicaid Dual eligibility.

717e65cc-0198-402c-8aeb-feccb569e942.doc: 1/13/2009                                         Page 1 of 1

Description: Inpatient Psychiatric Evaluation and Management Codes document sample