Author Topic: LCSW and Integrated Care  (Read 5616 times)

ask821

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LCSW and Integrated Care
« on: June 24, 2014, 09:06:32 PM »
I work for a LMHA  (Local Mental Health Authority) in Texas. With Integrated Care and 1115 waivers, we have a billing dilemma. We have a LCSW that has been privileged to do Mental Health diagnosis on admitted hospital patients when needed. We are pondering on how to bill for this service.                                                                                                                           We have many questions and so few answers. Do we bill as coordination of care or with an attending physician or without either? What would the place of service be ?                                                                                                                       Any help is greatly appreciated.     Thank you                                                               

PMRNC

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Re: LCSW and Integrated Care
« Reply #1 on: June 24, 2014, 09:24:20 PM »
You really don't give enough information.

Are you looking for billng on professional component or facility?
is this LCSW credentialed along with the rest of the group?
Linda Walker
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ask821

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Re: LCSW and Integrated Care
« Reply #2 on: June 24, 2014, 09:30:29 PM »
Will bill on professional component (cms 1500). LCSW is individually credentialed with Commercial Insurances,   Medicaid and Medicare.

kristin

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Re: LCSW and Integrated Care
« Reply #3 on: June 24, 2014, 11:58:33 PM »
Without knowing anything about mental health billing, I can hazard a guess that the POS needs to be where the LCSW saw the patient face to face. Be it inpatient hospital (21), inpatient psychiatric facility(51), psychiatric facility partial hospitalization (52) or psychiatric residential treatment center(56). Someone else correct me if I am wrong?

Michele

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Re: LCSW and Integrated Care
« Reply #4 on: June 25, 2014, 12:25:25 AM »
I believe Kristin is correct on the POS.  As for the rest I am not sure.  I don't think Medicare covers an LCSW seeing patients for the mental health codes with a POS of inpatient but I'm not sure about Integrated Care and 1115 waivers.  I would think it would be billed under the LCSW directly with the mental health codes.
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Re: LCSW and Integrated Care
« Reply #4 on: June 25, 2014, 12:25:25 AM »

ask821

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Re: LCSW and Integrated Care
« Reply #5 on: June 25, 2014, 12:47:10 PM »
Here are more details that might help solve this billing dilemma.

Integrated Care is the systematic coordination of general and behavioral healthcare. Integrating mental health, substance abuse, and primary care services produces the best outcomes and proves the most effective approach to caring for people with multiple healthcare needs.

With that said, I will give a couple of examples;

Patient is in hospital for diabetic related complications. Their Dr. see's that there might be an underlying 'psych issue' that is hindering their diabetic condition. Being that he does not specialize in psych, he calls in our LCSW for an assessment to evaluate his patient for any possible BH needs.

Patient had surgery and their Dr senses there might be depression that is causing a longer recovery time than normal. He wants our LCSW to do an assessment and see if there is any underlying BH issues cause a longer recovery time.

If this patient was seen in our office I would bill a 90791 CPT and 11 for POS on a CMS 1500 form.

With the conception of Integrated Healthcare, we are all scratching our heads on how to bill this and what components, if any we need to collect from the hospital or referring and/or attending Dr.

The hospital our LCSW is privileged at is not a Psych or Substance Abuse Hospital. Just a local medical hospital that we are partnering with for Integrated Care, if that helps.

Thank you so much

PMRNC

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Re: LCSW and Integrated Care
« Reply #6 on: June 25, 2014, 02:01:23 PM »
You DO have to change POS to 21
LCSW can  still use the CPT 90791 for your initial Eval. The new CPT codes 90791, 90832, 90834, 90837  are all face to face and include ANY setting such as office, inpatient hospital, Partial hospitalization, residential and even ALF.  You just need to make sure the LCSW is listed in proper areas on the CMS 1500 with all numbers and such.

Keep in mind depending on the hospitalization diagnosis codes by physician, insurances may or may not pay, many times patients will get a bill in mail and call carrier never having requested the LCSW services, happens all the time when I processed claims. I also had a therapist enter my room in the hospital after having my 2nd daughter because my dr thought it "might be a good idea since I had a 7  month old at home already."  :-\ :-\ :-\ ::) ::) :o  My insurance company requested the primary diagnosis and medical necessity and it was denied. Therapist tried to bill me but I refused to pay it.

 
Linda Walker
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ask821

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Re: LCSW and Integrated Care
« Reply #7 on: June 25, 2014, 02:40:40 PM »
Thank you Linda!

Do you have any suggestions when filing with Medicare and/or Commercial Carriers in this situation?? Where would one go to find out where the LCSW needs to be listed and in what fields on the CMS 1500? We've looked high and low and are having a hard time with this situation and if we will get paid. I've gone through my billing books and come up empty handed with this scenario.

Would this be considered a "coordination of care", out of curiosity??

Thank you!

PMRNC

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Re: LCSW and Integrated Care
« Reply #8 on: June 25, 2014, 06:23:47 PM »
Quote
Do you have any suggestions when filing with Medicare and/or Commercial Carriers in this situation?? Where would one go to find out where the LCSW needs to be listed and in what fields on the CMS 1500? We've looked high and low and are having a hard time with this situation and if we will get paid. I've gone through my billing books and come up empty handed with this scenario.

Would this be considered a "coordination of care", out of curiosity??

I don't know the specifics of your group setup, but generally the NPI need be in box 24J and 33 A for your scenario


I don't think this would be eligible for "coordination of care". http://www.socialworker.com/feature-articles/practice/Understanding_Care_Coordination%3A_Emerging_Opportunities_for_Social_Workers/

I would say that you will need to verify benefits with each carrier, as I stated previously, I've seen carriers deny coverage from visits from therapist or LCSW if it was not medically necessary. Your best bet is to make sure you check eligibility, verification, get authorizations where required and make sure documentation is readily available if asked for by the carrier.
« Last Edit: June 25, 2014, 06:29:15 PM by PMRNC »
Linda Walker
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ask821

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Re: LCSW and Integrated Care
« Reply #9 on: June 26, 2014, 11:25:55 AM »
Linda,

Thank you so much! I understand the boxes 24J & 33A. I am wondering if boxes 17, 17A, 17B and 18 would need to be filed out for payment? Your thoughts would on this be appreciated.

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Re: LCSW and Integrated Care
« Reply #9 on: June 26, 2014, 11:25:55 AM »

rdmoore2003

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Re: LCSW and Integrated Care
« Reply #10 on: June 26, 2014, 05:40:32 PM »
yes those boxes should be completed

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Re: LCSW and Integrated Care
« Reply #10 on: June 26, 2014, 05:40:32 PM »