Q. As a cost-cutting measure, my hospital is requiring attending psychiatrists to perform the required physical on every patient who is admitted to the psychiatric unit. I feel this is out of my scope of practice and my experience. So far, I have managed to see only patients whose insurance will cover the physical separately by an internist or someone else. How should this be coded?

A. As medical doctors, psychiatrists have been trained to do physicals. In some facilities the psychiatrist does both the initial evaluation and the physical; in others, the psychiatrist does just the initial psychiatric evaluation and someone else (for example, an internist) does the physical. Either practice is acceptable.

If the psychiatrist does the initial evaluation and physical, he or she can use 90801 or one of the 99XXX codes under "Initial Hospital Care" (for example, 99221, 99222, or 99223). If the psychiatrist does the initial evaluation and someone else does the physical, the psychiatrist can use the 90801 code, and the person doing the physical can use one of the 99211-99223 codes.

E-mail your CPT coding questions to HSF@psych.org, attention Becky Yowell, assistant director of the Office of Healthcare Systems and Financing. ▪