Medical Billing Forum

Coding => Coding => : rdmoore2003 November 27, 2012, 02:48:23 PM

: 2013 mental health codes
: rdmoore2003 November 27, 2012, 02:48:23 PM
I just received my 2013 cpt book.  I am confused a bit.  For mental health codes, it has listed that 90834 is psychotherapy 45 minutes with patient and/or family member.   Now, it shows that 90846 and 90847 are still active codes which is family therapy with and without patient present.   what is the difference between a 90834 and 90846/90847?
: Re: 2013 mental health codes
: PMRNC November 27, 2012, 03:22:53 PM
what is the difference between a 90834 and 90846/90847?

90834 is the new CPT for interactive (time with patient present) therapy 45 min    and 90846/90847 is for family psychotherapy w/w/out patient   
: Re: 2013 mental health codes
: rdmoore2003 November 29, 2012, 02:19:59 PM
just trying to figure things out on new codes.  let me know if I am at least on the right track, please.
provider sees an established patient for a medication check visit for 10 minutes without psychotherapy- old code billed was 90862-  new code just 99212 since no psychotherapy?

provider sees established patient for medication visit with minimal psychotherapy for 30 minutes- old code billed was 90805- new code billed is 99214 + 90833?  (99214 descriptions is 25 minutes whereas 90833 is described as 30 minutes?

Is this about right, Linda?
: Re: 2013 mental health codes
: PMRNC November 29, 2012, 07:03:56 PM
A 90862 should have never been used for a simple med check only .. 90862 was for a medcheck WITH MINIMAL psychotherapy. The HCPCS code M0064 should have been used for simple med check NO therapy.

provider sees established patient for medication visit with minimal psychotherapy for 30 minutes- old code billed was 90805- new code billed is 99214 + 90833?  (99214 descriptions is 25 minutes whereas 90833 is described as 30 minutes?

That sounds correct, assuming all elements of the 99214 or any E/M used meets all documentation/criteria.
: Re: 2013 mental health codes
: rdmoore2003 November 29, 2012, 07:40:58 PM
do you think we will have to use modifiers?
: Re: 2013 mental health codes
: rdmoore2003 November 29, 2012, 07:45:04 PM
A 90862 should have never been used for a simple med check only .. 90862 was for a medcheck WITH MINIMAL psychotherapy. The HCPCS code M0064 should have been used for simple med check NO therapy. quote]

sorry, I got my with and withouts messed up.

: Re: 2013 mental health codes
: Michele November 30, 2012, 01:03:46 PM
Modifiers for what?
: Re: 2013 mental health codes
: rdmoore2003 November 30, 2012, 04:40:41 PM
modifiers for the 99214 & add on code of 90833.  or will this be a bundled package
: Re: 2013 mental health codes
: Michele December 03, 2012, 10:49:48 AM
Are you billing for a psychiatrist who is doing medication management and also psychotherapy?  If so then you may want to look at the 25 modifier to indicate the E&M, 99214, is separate from the psychotherapy.  If you are billing for a psychologist or LCSW I don't believe the 99214 & 90833 would be appropriate together.
: Re: 2013 mental health codes
: PMRNC December 03, 2012, 11:23:28 AM
If so then you may want to look at the 25 modifier to indicate the E&M, 99214, is separate from the psychotherapy.

Why would a modifier be needed? The 90862 is being replaced with the appropriate E/M code for prescribers.  If there is NO therapy involved they need only bill the appropriate E/M code, however if they are doing therapy they will use the E/M code along with the new add appropriate add-on code for therapy.   
: Re: 2013 mental health codes
: Angie December 03, 2012, 12:46:55 PM
So if the "psychiatrist" was using 90817, 90819 or 90822 then do they stay the same with just the new add on codes:
90817= 90833
90819= 90836
90822= 90838

Or are all the 90817, 90819 and 90822 deleted and only use the 90833, 80836 and 90838?
I'm a bit confused myself........
: Re: 2013 mental health codes
: PMRNC December 03, 2012, 02:24:50 PM
90817= 90833
90819= 90836
90822= 90838

Right but remember, the psychiatrist will use those above codes 90833, 90836, 90838.(These are INPATIENT psychotherapy codes). WITH Appropriate E/M code 
: Re: 2013 mental health codes
: Angie December 03, 2012, 02:30:22 PM
It is for an inpatient Residential Treatment Center. So those are not add one codes; those are the codes he would begin using 2013? Correct?
: Re: 2013 mental health codes
: PMRNC December 03, 2012, 03:50:05 PM

It is for an inpatient Residential Treatment Center. So those are not add one codes; those are the codes he would begin using 2013? Correct?

If they are providing psychotherapy with their med management inpatient codes YES would be added on to the E/M a/o 1/1/2013
: Re: 2013 mental health codes
: Angie December 03, 2012, 06:41:52 PM
Where would you put the added codes on the CMS 1500 form?
Our Doc likes to use those; even though it is facility; it is only for professional charges provided by the psychiatrist; separate charge from daily rate.
: Re: 2013 mental health codes
: PMRNC December 03, 2012, 06:56:34 PM
It's just going to be on a separate line item.
: Re: 2013 mental health codes
: Angie December 04, 2012, 11:34:56 AM
So if his charge for 90819 is $220 he is going to have to split his charges out now?
90819 one charge and 90836 a different charge?
Because as of now his 90819 for $220 is for both psychotherapy w/ E/M......
: Re: 2013 mental health codes
: Angie December 06, 2012, 11:32:36 AM
So if his charge for 90819 is $220 he is going to have to split his charges out now?
90819 one charge and 90836 a different charge?
Because as of now his 90819 for $220 is for both psychotherapy w/ E/M......
: Re: 2013 mental health codes
: PMRNC December 06, 2012, 12:05:06 PM
With psychiatry, remember that physicians (prescribers/MD) have always been able to bill an E/M code as long as the documentation supported all elements of that E/M code.   For 2013 they took away the 90862 (med management) and instead physicians will bill the appropriate E/M code :  99204-99215 (outpatient)  99222-99233 (Inpatient)

90819 will cross walk to 90836 (45 min psychotherapy)      NOW if the physician is billing medication management they will use the appropriate E/M code, making sure that documentation supports all the elements of that E/M code.   It's important to note that the E/M you are using is not selected based on time because your psychotherapy code (90836, in this case) is based on 60 min. 

Now if your provider is ONLY providing medication management (NO THERAPY AT ALL) previously this was HCPCS code of M0064 (MED mgmt services only)   That will then say you can use the appropriate E/M code as long as documentation is there to show the elements of that E/M   

As for the use of modifiers you will follow the same guidelines as always when appending the appropriate and needed modifier to the E/M.    It looks confusing because many psychiatrists never really knew they COULD use E/M codes before but really all that has changed is the addition of therapy and breaking out the therapy FROM the med management.     If your provider is ONLY doing therapy they will ONLY use the Therapy codes.
: Re: 2013 mental health codes
: Angie December 06, 2012, 01:17:58 PM
Thanks Linda. Still a little confused on the whole E/M because he never really used them before so I will do some further research into that. He has always just used the same codes 90819 coding family.......
What is the difference in the new CPT coding book from the professional or standard? Is there a difference in the one you purchase?
: Re: 2013 mental health codes
: PMRNC December 06, 2012, 04:08:50 PM
I just get the spiral edition each year. I also get the specialty cards which is laminated and comes in handy for specific specialties.
: Re: 2013 mental health codes
: rdmoore2003 December 17, 2012, 01:22:57 PM
Are you billing for a psychiatrist who is doing medication management and also psychotherapy?  If so then you may want to look at the 25 modifier to indicate the E&M, 99214, is separate from the psychotherapy.  If you are billing for a psychologist or LCSW I don't believe the 99214 & 90833 would be appropriate together.

Thank you.   I bill for a Medical Psychologist and LPC's.   The M.P. does have rx rights.
: Re: 2013 mental health codes
: rdmoore2003 December 17, 2012, 01:29:59 PM
my only confusion now is since my medical psychologist (only 2 states have medical psychologists) now will be using e/m codes for his medication visits with therapy, are we to split the costs between the 2 codes?

example: say old code 90805, we charged $127.00
new codes will be say 99213 +90833, do we split the original $127.00 between the 2 codes or have an amount for each code?   and with these new codes, will I need to use 25 modifier on e/m code?
: Re: 2013 mental health codes
: rdmoore2003 December 17, 2012, 01:30:53 PM
sorry, 1 more thing.   is the moo64 code still going to be used?
: Re: 2013 mental health codes
: Michele December 19, 2012, 12:05:42 PM
I believe you would need the 25 modifier.  As for the charges, the provider should set a fee schedule for each new code based on what that code is worth.  I wouldn't just 'split the fee' of the old code.
: Re: 2013 mental health codes
: rdmoore2003 December 19, 2012, 12:57:24 PM
Thank you.   I participated in a webinar yesterday.  25 modifiers are not to be used since they are add on codes.  What a mess!!
: Re: 2013 mental health codes
: PMRNC December 19, 2012, 12:57:34 PM
I agree with Michele, this is biggest challenge for the prescribing NON psychiatrist, I suggest additional resources for him or her for eval and management. You will also want to create fee schedules for these codes.   The use of modifier 25 however I'm still trying to find out because why would you need it when the mental health therapy codes are "add" on's and already show the medication management part of the E/M IN it billed along with a therapy code (Why the hell do they mess with stuff that works??)   

As for M0064, that was a HCPCS only to be used for Psychiatrists who for NO other purpose saw patient regarding meds, maybe quick dosage check or adjustment, I don't believe it was ever payable to psychologists. They mainly created that code to prevent overcharging/fraud that mostly goes on for inpatient treatment and nursing home visits.
: Re: 2013 mental health codes
: PMRNC December 19, 2012, 01:00:59 PM

Thank you.   I participated in a webinar yesterday.  25 modifiers are not to be used since they are add on codes.  What a mess!!

I see you typed that before I finished my post :)  I agree. .MESS.    one of my clients did a mini meet with some colleages to which I sat in on and he said same thing.. don't need modifier 25. Modifier 25 was never used anyway to affect reimbursement so now that we have the add on codes for the E/M wouldn't need modifier 25.. YOU WOULD THINK.. however..      I took an online webinar class where they say it should be appended to the E/M  :o :o :o :o  I wrote to them and see what they say.   I took a LOT of notes so I'm trying to find a way to upload them to our mental health area. As there is going to be MASS confusion.. especially for your psychologists who are not used to using E/M
: Re: 2013 mental health codes
: rdmoore2003 December 19, 2012, 01:15:45 PM
thanks Linda.   Years ago, I transferred over to mental health with psychologists and LPC's to get away from E/M codes.  Well, I enjoyed it while it lasted....
: Re: 2013 mental health codes
: rdmoore2003 December 19, 2012, 01:17:39 PM
I contacted my state workers compensation yesterday.   It is a shame, that my state has not updated cpt codes since 2001.  Why is it that state w/c does not have to follow same updates/laws as all others?   They do not have any plans on updating for 2013 codes, either.
: Re: 2013 mental health codes
: PMRNC December 19, 2012, 03:05:06 PM
They don't have to follow same rules in regards to coding. Even some TPA's are a year or more behind with codes.  HOWEVER.. don't quote me on this.. but if you bill out CURRENT codes..they can't deny, it may HOLD the claim up but I do NOT think they can deny for using old codes.
: Re: 2013 mental health codes
: Michele December 21, 2012, 12:49:18 PM
Great info!  There is already so much confusion!  We are in the process of updating our mental health book as well but the info out there is contradicting.  We want to make sure we get it all correct.  Even the insurance companies don't know all of the new rules!
: Re: 2013 mental health codes
: PMRNC December 21, 2012, 01:57:55 PM
They really are not as confusing as people think. A few changes to the Superbills and NON psychiatrists will need some help getting used to E/M :)
: Re: 2013 mental health codes
: ledwards January 02, 2013, 02:54:06 PM
in the CPT code book under the Psychotherapy topic it states " some psychiatric patients receive a medical evaluation and psychotherapy on the same day by the same physician or other qualified health care professional." Does this mean a psychiatrist and see the patients for e/? services and a LPC provide the therapy????  99212 and 90833 to be billed together with two different providers???
: Re: 2013 mental health codes
: PMRNC January 02, 2013, 03:56:51 PM
When you look at the new coding descriptors you will notice they no longer say "with pharmacologic management (med management)"  When you see, instead "with medical services" that is what is being done, meds are involved to treat the medical portion of the visit's reason. Your LPC will NOT be able to use E/M at all. MOST (actually probably all) plans never allowed more than one visit a day, so IF you have two providers (one for the med management only) and one for the therapy, you will want to check with the carriers to see how that would work. Formerly a psychiatrist could bill a 90862 which included not just med management but "minimal therapy". If the services are going to be broken out to accommodate the licensing requirements of, for example, an LPC, they will be only be able to bill for the therapy and the prescribing physician/therapist (Therapists in NM and LA, can prescribe meds) will ONLY be able to bill the appropriate E/M. 
: Re: 2013 mental health codes
: Angie January 02, 2013, 05:51:00 PM
Just so I am clear:
If my psychiatrist does both on the same day he is going to have to break it out and have one charge for the therapy portion and one charge for med mang. Correct? They will have to be two separate services pretty much; two line items on the claim; even if most of it is therapy and maybe 10 minutes is med mang.
It will not be covered because most insurance companies only cover 1 session per day!
: Re: 2013 mental health codes
: PMRNC January 02, 2013, 06:42:44 PM
Just so I am clear:
If my psychiatrist does both on the same day he is going to have to break it out and have one charge for the therapy portion and one charge for med mang. Correct? They will have to be two separate services pretty much; two line items on the claim; even if most of it is therapy and maybe 10 minutes is med mang.
It will not be covered because most insurance companies only cover 1 session per day!

Correct. If your psychiatrist had never used E/M codes it would be a good idea to put a fee schedule together to cover the appropriate E/M codes. I've always advised my psychiatrists to utilize E/M when documentation substantiates it so this is not news for them, they are just now going to have to use the add/on therapy codes when necessary. Mostly therapists and non psychiatrists will have the hardest trouble with the new coding method.
: Re: 2013 mental health codes
: Angie January 03, 2013, 07:15:32 PM
He is an M.D. Psychiatrist and no he has not been using the E/M so yes this is a change!
Where on the CMS 1500 form do you put the add on code? I'm confused.....obviously!
Example:
He does med mang 20 minutes on 1/1/13 and in that same session he does 30 minutes of psychotherapy (90833).
Would you put them on a separate line item on the claim form?
: Re: 2013 mental health codes
: PMRNC January 04, 2013, 12:44:24 PM
Each CPT Code will be on it's own line. Your E/M will be on one line, and your Add on code will be on the next line. E/M code would come first. Not sure it matters but that's way I was always taught.

The providers med management services would be a part of the E/M appropriate for that visit and of course documented. The Add on code for psychotherapy would then go on the next line depending on the time, for your example would be the 90833 (30 min or 16-37 min)
: Re: 2013 mental health codes
: wbh January 04, 2013, 08:50:40 PM
Just curious does anyone know if you bill a 99213, 99214 or 99215 by themselves, are they considered the old Med management codes as in they are not usually counted against a patients therapy visit limit? Or are they considered a therapy visit used with the add-on codes?  If billing a 99 code w/an add on code does that make it a therapy visit and it goes against a patient's therapy visit limit?

Also the 90837 replaces the 90808, did the 90808 require a special authorization from insurances & if yes, will the 90837 now require a special authorization too?
: Re: 2013 mental health codes
: PMRNC January 05, 2013, 02:10:36 PM
Just curious does anyone know if you bill a 99213, 99214 or 99215 by themselves, are they considered the old Med management codes as in they are not usually counted against a patients therapy visit limit?

If your psychiatrist used to bill a 90862 for med management with minimal therapy, they would indeed use one of the above E/M codes (documentation should support the code) in substitution of the old 90862.   Now if your provider in the past ONLY did quick med checks NO THERAPY.. they should have been using M0064.   You do not get to use the therapy add on codes with the E/M unless there is psychotherapy being done with the med management.

Or are they considered a therapy visit used with the add-on codes?  If billing a 99 code w/an add on code does that make it a therapy visit and it goes against a patient's therapy visit limit?

You are only going to use the add on therapy codes with the E/M in cases where provider is doing any medical service (physical, med mgmt) AND psychotherapy.

Also the 90837 replaces the 90808, did the 90808 require a special authorization from insurances & if yes, will the 90837 now require a special authorization too?

That is carrier specific, the carrier will determine authorization procedures.
: Re: 2013 mental health codes
: Buglet10 March 07, 2013, 02:50:19 PM
I have Mass BC/BS form here explaining new codes and they state 90834 is Psychotherapy 45 mins. with patient and/or family member.  No explanation of 90847 assuming still family but where is the breakdown if you can bill either now with family member.  Medicare breakdown 90834 Psytx  if pt and or family member. 90847 family psytx w/ pt.  Doesn't that seem like you can use either?  Makes no sense.
I usually bill 90834 if just pt or just parent talking about pt.  I use 90847 when the family is in the session for any period of time.  Be interested in finding out what others re doing.
: Re: 2013 mental health codes
: Coffeecat21 February 17, 2015, 06:38:52 PM
How do I code a 1/2 session (25min.) for 90847?  There are no time ranges for family therapy w/patient.
: Re: 2013 mental health codes
: PMRNC February 17, 2015, 06:48:13 PM
You might be out of luck... Your 90804 became a 90832 (30 min)..  You are going to to need to counsel your client to complete the full 30 min.. That's actually ONE of the reasons the codes were changed.
: Re: 2013 mental health codes
: rdmoore2003 February 17, 2015, 07:48:48 PM
90832 Code shows a range from 16-37 minutes.