F68.A — Factitious disorder imposed on another
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Billing, coding, and required claim documentation must follow the requirements specified in LCD L37633 (see that LCD for required medical records, prior authorization, and claim submission documentation).
- Claims must meet the reasonable and necessary requirements described in the related LCD (L35101); providers must retain medical record documentation supporting medical necessity per the LCD.
- When billing for services that are not covered, the claim must include the appropriate modifier to indicate non-coverage status.
- When a second provider bills a diagnostic interview for a beneficiary they are seeing for the first time, documentation should support that it is the provider's first encounter with the beneficiary.
Key Coverage Criteria
- Partial Hospitalization Program services that meet the coverage criteria of Local Coverage Determination L37633 are considered covered.
- Diagnostic interview codes (e.g., CPT 90791/90792) are indicated for the initial evaluation of a beneficiary, and a second provider seeing the beneficiary for the first time may report diagnostic interview codes for that initial encounter.
- CPT code 96105 is indicated for formal evaluation of aphasia using a standardized instrument (for example, the Boston Diagnostic Aphasia Examination).
- HCPCS codes G0017 and G0018 are appropriate for services provided in non-facility places of service other than Office.
- A psychiatric diagnostic evaluation (CPT 90791) or with medical services (CPT 90792) may be performed once at the onset of an illness or suspected illness.
- A psychiatric diagnostic evaluation (90791/90792) may be repeated for the same patient after an extended break (~6 months) in treatment, upon admission to inpatient psychiatric status, for a significant change in mental status, in a patient with established neurological disorder or dementia with acute/marked mental status change, or for a second opinion/diagnostic clarification.
12 Active Policies
A57480 — Billing and Coding: Psychiatry and Psychology Services
J05
L34616 — Psychiatry and Psychology Services
J05
A57520 — Billing and Coding: Psychiatric Diagnostic Evaluation and Psychotherapy Services
J09
A57780 — Billing and Coding: Psychological and Neuropsychological Tests
J09
Related Codes
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