About this policy
The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Home Health - Psychiatric Care L34561. Diagnostic Criteria A Patient must have a diagnosis as defined in the Diagnostic and Statistical Manual of Mental Health Disorders, 5th Edition, DSM-5™. This diagnosis must match the diagnosis that the ordering physician is treating and/or for which the patient was hospitalized. This diagnosis must be fully documented and available in the medical record. The DSM-5™ has combined Axis III with Axes I and II. Clinicians should continue to list medical conditions that are important to the understanding or management of an individual's mental disorder as opposed to personality disorders, mental retardation, general medical conditions, psychosocial and environmental problems and global assessment of functioning. Billing When Separate Visits Were Made for Medical and Psychiatric Nursing Care Psychiatric nursing care is not separately billable from non-psychiatric nursing care. Both of these services constitute skilled nursing care and may be furnished by the psychiatric nurse, in the course of a single visit. Therefore, visits will not be covered for 1 nurse to provide psychiatric nursing care and another to provide non-psychiatric nursing care, unless the non-psychiatric nursing care is of such a highly specialized and technical nature, that the service could not be safely rendered by the psychiatric nurse (e.g., infusion therapy).
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
| Code | Code system | Status in this policy |
|---|---|---|
| G0152 | HCPCS | Covered |
| G0155 | HCPCS | Covered |
| G0156 | HCPCS | Covered |
| G0299 | HCPCS | Covered |
| G0300 | HCPCS | Covered |
| F03.90 | ICD10CM | Covered |
| F03.911 | ICD10CM | Covered |
| F03.918 | ICD10CM | Covered |
| F03.92 | ICD10CM | Covered |
| F03.93 | ICD10CM | Covered |
| F03.94 | ICD10CM | Covered |
| F03.A0 | ICD10CM | Covered |