Understanding mental health billing and coding is a complex process. Different aspects of care require staff to follow unique codes. This blog will break down which codes your practice should use for specific circumstances.
Here are the top elements to keep in mind to maintain accurate mental health billing services.
Practices use the International Classification of Diseases (ICD) coding system to bill for diagnoses. Treatment billing has two code options: Current Procedural Terminology (CPT) and the Healthcare Common Procedure Coding System (HCPCS).
The ICD-10-CM model provides a classification system for diseases and injuries. Practices report diagnoses using this model to both private and public insurers.
The American Medical Association developed CPT codes. This system has numbers associated with each service a physician may provide. Insurers use these numbers to determine how much reimbursement to provide a practice.
The procedural codes for mental health (codes90785-90899) are found in the Psychiatry section of the CPT code set. Codes originating from this section can be delivered by clinical psychologists, licensed professional counselors, licensed marriage and family therapists, and licensed clinical social workers.
Coders use HCPCS codes when dealing with Medicare and Medicaid.( The Centerfor Medical Services (CMS) monitors this code set. Both programs use Level 1and Level 2 codes. Medicaid typically uses Level 2 codes, and Medicare typically uses Level 1 codes. Medicaid has exclusive access to some Level 2codes.
Most mental health Providers code only Using Level 1 Codes. Medicaid required to use Level 2 alphanumeric codes that are provided by non physicians HCPCS Code range from H0001- H2037
Physicians spend significant time counseling patients and coordinating patient care. These actions fall under Evaluation and Management (E/M) services. It's easier to justify high levels of E/M compared to other services. Therefore, they frequently receive higher reimbursement levels.
As defined by CPT codes, counseling must involve a discussion with a patient, and/or their family, or another care giver. This conversation must involve one or more of the below categories.
● Patientand family education
● Recommended diagnostic studies
● Diagnostic results
● Risks and benefits of management (treatment) options
● Management (treatment) instructions
● Significance of complying with chosen management (treatment) options
● Riskfactor reduction
When documenting services, your staff must maintain consistent standards. Failing to accurately record procedures is devastating to long-term stability. To avoid this destabilization, your medical records should support codes you included in an insurance claim.
Ensure that your physicians are writing legibly and including all necessary treatment details. These details include:
● Reasonfor visit
● Relevanthi story
● Examination findings
● Priordiagnostic test results
● Clinical impression
● Planfor care
● Identity of observer
Unless easily inferred, physicians must document the reason for ordering ancillary services and diagnosis. Also, identify appropriate health risks, patient's progress, response to change, and revisions to diagnosis.
Coding complexitie scan overwhelm an Mental Billing. Consider hiring a professional coding company to reduce the stress your staff endures. Plutus Health offers an expert team that excels at accurately coding services and billing quickly. Talk with a representative to hear how we’llimprove your practice’s financial processes.
1. Know the distinction between diagnostic and treatment services.
2. Learn the ICD and CPT overviews.
3. Understand nuances in HCPCS codes.
4. Study when a conversation falls under Evaluation and Management.
5. Keep accurate and detailed medical records.
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