Description of the presenting problem—both the behavioral health concern and/or the parenting concern. Description of the history of the presenting problem—how long presenting problem has occurred including intensity and duration. Past treatment/services—related to both the behavioral health concern and/or the parenting concern. History of the member’s involvement with CPS/YS, services, and outcomes. Pertinent medical history. Mental Status Examination related to presenting problem. Diagnosis rendered within DSM format and rationale. Recommendations for future services—related to the behavioral health condition as well as parenting concern Prognosis including rationale—related to the behavioral health condition as well as parenting concern. Must indicate a physical examination/review – and ordering of diagnostic tests Collateral interview must be summarized within the report and include: Name and (If applicable) of person. Their relationship to the case. The date of the contact documented. A summary of the information The mode of the contact- face to face interview, e-mail, phone, etc. Records reviewed related to the case and referral question. Records reviewed should be listed and summarized within the report. Each record reviewed must be documented in the report with: Title of Document and date Date of record review Number of pages per document How the records were obtained Brief Summarization of documents reviewed The report should contain the following components of the psychological testing as outlined within the 96101 CPT code: Results (Scores and Categories) of the administered tests Interpretation of the administered tests Service Exclusions Special Evaluations do not include the following: Travel time to a location such as the DHHR office to conduct the evaluation. Service Exclusions MDT attendance or preparation of summaries for MDTs Testimony Observation of parent/child interaction (i.e. observation of supervised visit between parent and child)
Description of the presenting problem—both the behavioral health concern and/or the parenting concern. Description of the history of the presenting problem—how long presenting problem has occurred including intensity and duration. Past treatment/services—related to both the behavioral health concern and/or the parenting concern. History of the member’s involvement with CPS/YS, services, and outcomes. Pertinent medical history. Mental Status Examination related to presenting problem. Diagnosis rendered within DSM format and rationale. Recommendations for future services—related to the behavioral health condition as well as parenting concern Prognosis including rationale—related to the behavioral health condition as well as parenting concern. – Must indicate a physical examination/review and ordering of diagnostic tests Collateral interview must be summarized within the report and include: Name and (If applicable) of person. Their relationship to the case. The date of the contact documented. A summary of the information The mode of the contact- face to face interview, e-mail, phone, etc. Records reviewed related to the case and referral question. Records reviewed should be listed and summarized within the report. Each record reviewed must be documented in the report with: Title of Document and date Date of record review Number of pages per document How the records were obtained Brief Summarization of documents reviewed The report should contain the following components of the psychological testing as outlined within the 96101 CPT code: Results (Scores and Categories) of the administered tests Interpretation of the administered tests Service Exclusions Service Exclusions Special Evaluations do not include the following: Travel time to a location such as the DHHR office to conduct the evaluation. MDT attendance or preparation of summaries for MDTs Testimony Observation of parent/child interaction (i.e. observation of supervised visit between parent and child)
um-guidelines-for-special-evaluations.docx