The outpatient psychiatric limitation in HI 00610.480 is applied to the physician's therapeutic services but not to his diagnostic services
(except those administered to follow the progress of a course of psychiatric treatment
for a diagnosed condition).
An initial visit to a psychiatrist for his personal professional services often combines
diagnostic evaluation and the start of therapy; such a visit is neither solely diagnostic
nor solely therapeutic. The initial visit is deemed to be diagnostic so that the limitation
does not apply. Separating diagnostic and therapeutic components of a visit is not
administratively feasible, and determining the entire visit to be therapeutic is not
justifiable since some diagnostic work must be done before even a tentative diagnosis
can be made, and certainly before therapy can be instituted. Moreover, the patient
should not be disadvantaged because therapeutic as well as diagnostic services are
provided in the initial visit. Similarly, when a physician's diagnostic psychiatric
services take more than one visit, the limitation does not apply to the additional
visits, When a physician bills for more than one visit for his personal professional
diagnostic services, the claim must be documented to show the reason(s) for more than
one diagnostic visit.