The outpatient psychiatric limitation in HI 00610.480 is applied to the physician's therapeutic services but not to the physician's 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 the psychiatrist's 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 the physician's
personal professional diagnostic services, the claim must be documented to show the
reason(s) for more than one diagnostic visit.