Medical Billing Forum
Coding => Coding => : Leslie Bartley May 11, 2011, 04:39:36 PM
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I am a partner for a new community mental health center - partial hospitalization program. We will electronically bill only Medicare claims. We have been granted a Medicare provider number.
We are starting to bill Medicare electronically for the services and procedures we provide. We have almost got our CMS 1500 template completed, but we are having problems with line 24F - Procedures, Services & Supplies. Through our Psychiatrist's Office we contacted other providers who are using our psychiatrist and offer the same services that we do. They said that they use the HCPCS codes G0176 (revenue code 0904) for Activity Therapy, G0177 (revenue code 0942) for Patient Education and G0411 (revenue code 0915) for Group Therapy. When we contact Pinnacle Medicare (Louisiana) they direct us to their website. When we enter the codes into the Physician Fee Schedule It tells us that there is no such code found.
When we called Pinnacle Medicare for an explanation they said that using these codes would result in denied claims. They said that we had to use CPT codes, but could not direct us to the codes we need to use. I have ordered a CPT coding book, I searched the internet, and I ordered all of Medical Billing's books in the hope that I could get some direction.
I found this article on the internet when looking up codes: CMS Manual System - Pub 100-04 Medicare Claims Processing. Centers for Medicare & Medicaid Services (CMS), Transmittal 2141, Date: January 24, 2011, Change Request 7271. This manual indicates that Medicare will pay for the above HCPCS codes. I'm totally confused.
Gateway, EDI are scheduled to run a test on several claims tomorrow. I can't submit any claims until I can find the proper service codes.
Thank You for Your Help;
Leslie E. Bartley, Ph.D.
We are not in a position to hire a medical biller, therefore, it falls to me to work this out.
We urgently need to begin submitting claims, but I don’t want to have them rejected.
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Leslie,
I think you are looking for CPT codes 90801-90899.
I don't see a code specifically for activity therapy but there are codes for interactive psychotherapy (90810-90815). The code for group therapy is 90853. I don't see a code specifically for patient education either, but there is a code for unlisted procedure - 90899.
I hope that helps. Please post back if you need more info.
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Thank You for this information. We have spent two weeks looking for these codes. Are there any modifiers that should go with these codes, like the one for unspecified procedure?
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Not any specific modifiers for mental health codes. None for the unlisted one but expect to have them request a description of services. In fact include one with the claim!
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Thanks for this wonderful advice. When submitting an explanation for an unlisted procedure, where do you put it for an electronic claim?
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Leslie, where are you located? I work for a medical psychologist and can help with anything you need.
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I'm in Shreveport, LA. We will submit our billing electronically to Pinnacle Business Solutions in Little Rock, AR. We are a CMHC, partial hospitalization program (stand alone). We are only setup to service Medicare clients.
We have been handicapped as our CPT coding book hasn't arrived and we are not sure what we should be billing and when. I just learned that food and transportation costs could not be billed.
Is there a publication which outlines what mental health procedures and services are billable? Could you give me the CRT codes for each of the following if they are billable?
In addition to the above questions, here are a few more.
1. Do we bill separately for doing the initial intake interview and paperwork, before the Psychiatrist sees the client?
2. Do we bill separately for testing, such as the Burn's Anxiety Inventory, the Burn's Depression Checklist, the Rosenberg Self-Esteem Scale, personality tests, etc.?
3. Do we bill separately for writing a report on each test?
4. Do we bill separately for developing a Master Treatment Plan and each 30 days a Treatment Plan Review?
5. When the Psychiatrist does a 30 day re-certification evaluation what code would we use. We were told that the initial certification is a one time billing.
Thank You so Much for your offer to help.
Blessings,
Leslie E. Bartley, Ph.D.
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Box 43 on the UB04 is for the description, if you are billing on a CMS you could try putting it in box 19.
Questions 1-4 I would think would be part of the room & board charges for the partial hospitalization.
Question 5 - the psychiatrist could charge an E&M visit (99211-99215) or a therapy visit (90804-90808).
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I'm not grasping the "room and board" concept. Are you saying that writing the Master Treatment Plan is part of coding 90801? Writing the Master Treatment Plan is developed by the counseling staff after the Psychiatrist provides her diagnosis.
Writing the Treatment Plan Review is done by the counseling staff each 30 days after the 90801 for the Psychiatrist to do a 90807. Is this considered part of the 90807?
Are their codes for when the nurse takes patient's vital statistics - blood pressure, sugar, weight, etc.?
Thanks for your help.
Leslie E. Bartley, Ph.D.
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As a partial hospitalization program are the patients staying at the facility? If so, don't you have a room & board charge? Or are they just receiving outpatient services and there is no facility fee?
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Our clients stay from 9:00 am to 1:30 pm (M-F). They are provided with transportation, a snack and lunch; in addition to four services. As we are just beginning to bill we didn't know about a room and board cost. What CPT code would that come under?
Blessings,
Leslie E. Bartley, Ph.D.
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I don't think that would qualify for room & board. There is no cpt for room and board, just rev codes. I am not familiar with billing for services such as this. I'm thinking that you will only be able to bill for the individual services that are provided. I'm not aware of any codes to use for what you've described. There are psychological testing codes that may apply. The following may be quite helpful:
https://www.cms.gov/transmittals/downloads/R765HO.pdf
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Michele,
Thanks you for all the advise you have given about coding for Medicare. I believe we are set to send in, electronically, our first billings. This has been a year long journey. Without your help and patience we could not have come this far. After weeks, our CPT coding book arrived yesterday.
Your eBooks are great and I recommend them to anyone that is beginning the medical billing journey.
Blessing,
Leslie E. Bartley, Ph.D.
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Michele,
What is the difference between 90801 and a 96150? I'm trying to figure out how to code and bill the following sequence:
1. Day One: Client and our nurse obtain & record intake data on the client (name, address, phone, email, contact person, social security number, medicare number, discuss client's complaint, etc.)
2. Day Two: Our social worker administers three test.
3. Day Three: Our Psychiatrist reviews client's file and conducts a diagnostic interview with the client. Our social worker is also consulted in the process. The Psychiatrist evaluates and makes a formal diagnostic.
4. Day Four: Our Social worker develops a Master Treatment Plan in keeping with the Psychiatrist's diagnostic goals and objectives.
5. Day Five: The Psychiatrist reviews the Master Treatment Plan, makes any additions, and signs off.
6. Day Six: Admitted client begins the daily program designed for the client.
7. In 30 days the client is re-certified (Recert) and every 30 days until the client is discharged.
Any help would be greatly appreciated.
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96150-96151 are reported assessment of psychological, behavioral, emotional, cognitive, and relevant social factors that can help to prevent, treat, or manage physical health problems. The assessment must be associated with an acute or chronic illness, the prevention of a physical illness or disability, and the maintenance of health. The initial assessment (96150) and re-assessment (96151) apply to each 15-minute direct, face-to-face session with the patient. A reassessment (96151) is reported to obtain objective measures of goals formulated in the initial assessment and to modify plans as is indicated to support the goals.
This web page also has a lot of info on this: http://www.priorityhealth.com/provider/manual/auths/~/media/documents/medical-policies/91546.ashx
90801 is a Psychiatric diagnostic interview examination.
You may also want to look at codes 96100 - 96117.
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Several weeks ago I asked about a CPT code for Activity Therapy. You said "I don't see a code specifically for activity therapy but there are codes for interactive psychotherapy (90810-90815)." When I finally got my CPT Coding Book, I looked up these codes and they refer to individual psychotherapy. Would these codes apply to a group setting of about 10 to 12 individuals?
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There does not seem to be any code specific to activity therapy in a group setting. You will have to pick the cpt code that most closely describes the service you are performing. I'm not sure how you could indicate that it was group as opposed to individual.
Anybody have any insight on this??
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Leslie & Michele:
I was checking this out today and agree that this "Activity Therapy" is a very confusing billing scenario. All the documentation points to using G0176; however, the only billing references I find are to use this code in conjunction with revenue codes, which get billed to Medicare Part A and get paid to the facility. G0176 is not listed on any state's Medicare Part B Physician fee schedule, and the Medicare Master Fee Schedule lists this code with a status indicator "P" (Partial hospitalization; Paid under OPPS - Outpatient Prospective Payment System; Per Diem APC Payment).
Leslie, when you indicated that you had been granted a Medicare Provider Number, was that issued as your (physician) provider number? Or, could that have been a number assigned for the community mental health care facility to use on their billing?
I'll also keep an ear out on some other blogs to see if this issue has come up with any other providers.
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Medicare granted us a provider number for our CMHC with Partial Hospitalization Program. We are not yet approved for Medicaid services (Part A).
In reference to:
G0176 is not listed on any state's Medicare Part B Physician fee schedule, and the Medicare Master Fee Schedule lists this code with a status indicator "P" (Partial hospitalization; Paid under OPPS - Outpatient Prospective Payment System; Per Diem APC Payment).
We are a Partial Hospitalization Program. The Medicare Contractor for Louisiana is Pinnacle Business Solutions in Little Rock Arkansas. Looking in Medicare Part B, at their Physician Fee Schedule, entering G0176, G0177, G0410 and G0411; there is no payment for these codes.
Louisiana has started a Pre-Payment Probe Review for Group Psychotherapy. We are a new company, having only recently submitted our first claims to Medicare. I'm concerned that I have not used the proper codes. In the light of the probe into Group Psychotherapy, even though it is for Part A - Medicaid; I need to have all my records and billing codes correct.
Any assistance would be appreciated.