Psych eval

edrobinson@regmed.comedrobinson@regmed.com
in Home Care Coding General
Hoping someone can help me on this. We have a patient that has been admitted since April and the RN casemanager wants to put in for a Behavioral Health (Psych) eval. Our agency just started offering a psych nurse so I am unsure if the only steps needed are for the RN casemanager to call the MD and get the approval and referral faxed to us? And even then would it just be a SN eval profile/note done or just a routine visit added in for the psych visit?
So far we have only had 3 Psych admits and the Psych nurse has done the admit and visits with no other disciplines added in.
I guess I am having a problem trying to show/distinguish the diff. between the RN casemanager vs the Psych nurse on our contacts/profiles. We don't anthing specific loaded in our system to say Behavioral Health/Psych nurse visit.
Any help is greatly appreciated in this!!

Thanks,
Heather Bonnette

Comments

  • Nancy.Wolverton@kindred.comNancy.Wolverton@kindred.com
    edited April 2017
    In the VNA I worked for in the past, we had a certified Psych RN who did psych evals.
    Any speciality eval I believe needs a VO from the physician including diagnosis addressed by the eval. Also , does the "case manager" intend to keep the patient for non-psych billable SNV's as well?
    If the patient is being transferred to a psych service solely for a psychiatric diagnosis (primary) and takes the skills of a qualified psych nurse to intervene under a psych POC, then better follow Medicare rules: see Medicare Benefit Manual, HH, Chapter 7, section 40.1.2.15 for specifics.

    Nancy Wolverton RN,CCM
    QR Specialist, Central Office
    5800 West 10th St., Suite 300
    Little Rock, AR. 72205
    Ph# 501-280-4913
    Fax# 501-280-4385
    Nancy.Wolverton@arkansas.gov
  • Nancy.Wolverton@kindred.comNancy.Wolverton@kindred.com
    edited April 2017
    Here's the benefit explanation:

    40.1.2.15 -Psychiatric Evaluation, Therapy, andTeaching (Rev.207, Issued: 04-10-15, Effective: 05-11-15, Implementation: 05-11-15)
    The evaluation, psychotherapy, and teaching needed by a patient suffering from a diagnosed psychiatric disorder that requires active treatment by a psychiatrically trained nurse and the costs of the psychiatric nurse's services may be covered as a skilled nursing service. Psychiatrically trained nurses are nurses who have special training and/or experience beyond the standard curriculum required for a registered nurse. The services of the psychiatric nurse are to be provided under a plan of care established and reviewed by a physician.
    Because the law precludes agencies that primarily provide care and treatment of mental diseases from participating as HHAs, psychiatric nursing must be furnished by an agency that does not primarily provide care and treatment of mental diseases. If a substantial number of an HHA's patients attend partial hospitalization programs or receive outpatient mental health services, the Medicare contractorwill verify whether the patients meet the eligibility requirements specified in §30and whether the HHA is primarily engaged in care and treatment of mental disease.
    Services of a psychiatric nurse would not be considered reasonable and necessary to assess or monitor use of psychoactive drugs that are being used for nonpsychiatric diagnoses or to monitor the condition of a patient with a known psychiatric illness who is on treatment but is considered stable. A person on treatment would be considered stable if their symptoms were absent or minimal or if symptoms were present but were relatively stable and did not create a significant disruption in the patient's normal living situation.

    Nancy Wolverton RN,CCM
    QR Specialist, Central Office
    5800 West 10th St., Suite 300
    Little Rock, AR. 72205
    Ph# 501-280-4913
    Fax# 501-280-4385
    Nancy.Wolverton@arkansas.gov
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