Author Topic: telephone calls and after hour service  (Read 3685 times)

ste

  • Full Member
  • ***
  • Posts: 102
telephone calls and after hour service
« on: February 22, 2010, 12:51:33 PM »
I am putting together a patient encounter for a client. I was given the telephone consulting codes 99371, 99372, and 99373 to put into the encounter form. However, when I look these codes up in the CPT 2009 standard edition (I know I should be using the 2010 edition) such codes do not exist. I can only find 99441, 99442, and 99443 for telephone consulting. Another code given to me, 99054, does not exist. Given the provided description of the code I think the physician meant 99051. Out of 9 codes provided 4 are wrong, or outdated, or maybe I'm wrong? I made a draft of an encounter using my corrections and I plan to show it to the physician and explain my reasons for changing it. I know legally I am not allowed to code and perhaps this is not even considered coding because I am not entering codes onto a claim form, but nonetheless it seems I'm walking on thin ice. Any suggestion?     

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4761
    • Solutions Medical Billing
Re: telephone calls and after hour service
« Reply #1 on: February 22, 2010, 06:20:58 PM »
This would not be considered coding, you are advising the provider that the codes they are currently using have been deleted and you are recommending that they use the replacement codes.  It should be a feather in your cap that you caught the codes.   8)

Michele
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

Cherylwilli

  • Newbie
  • *
  • Posts: 22
Diagnosis codes
« Reply #2 on: February 25, 2010, 02:20:28 PM »
I bill for mental health providers and a new provider is using "V" codes for patient diagnosis, i.e. "v71.09" as the second dx.  I was told by another colleague that V codes are no longer used and can cause denials.  Can anyone tell me what their experience and/or knowledge is regarding V codes?  Thanks.

Cheryl

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4761
    • Solutions Medical Billing
Re: telephone calls and after hour service
« Reply #3 on: February 25, 2010, 03:25:42 PM »
There are many valid v codes and some apply to mental health.  We bill for over 20 MH providers but most do not use V codes regularly.  I personally haven't seen any denials specifically due to v codes. 

Michele
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

Cherylwilli

  • Newbie
  • *
  • Posts: 22
Re: telephone calls and after hour service
« Reply #4 on: February 25, 2010, 03:32:12 PM »
Michelle,

None of my other providers use V codes either.  I'll submit with the V code she used and see what happens.  Thanks for your quick response.

Cheryl

Pay_My_Claims

  • Guest
Re: telephone calls and after hour service
« Reply #5 on: February 25, 2010, 06:20:20 PM »
cheryl I use vcodes and don't get denials from them

Meli

  • Full Member
  • ***
  • Posts: 144
  • Melissa Turner
    • Mainstream Services Inc.
Re: telephone calls and after hour service
« Reply #6 on: May 14, 2010, 06:59:41 PM »
Hi all,

I have a question related to this topic.  Has anyone used S9484 for Mental Health billing?  I have a MH provider I am billing for and she held an emergency telephone session for 60 minutes.  This is the first time using this code so a bit curious. 
Melissa Turner, CPMB
Mainstream Services Inc.
www.msmbinc.com

Pay_My_Claims

  • Guest
Re: telephone calls and after hour service
« Reply #7 on: May 15, 2010, 07:20:49 AM »
she is billing that from a telephone call???

Meli

  • Full Member
  • ***
  • Posts: 144
  • Melissa Turner
    • Mainstream Services Inc.
Re: telephone calls and after hour service
« Reply #8 on: May 15, 2010, 03:36:19 PM »
Yes.  It was a 60 minute crisis intervention.
Melissa Turner, CPMB
Mainstream Services Inc.
www.msmbinc.com

Pay_My_Claims

  • Guest
Re: telephone calls and after hour service
« Reply #9 on: May 15, 2010, 07:40:32 PM »
humm, I don't think it can be used for telemedicine services..... it is crisis intervention but it is a code used for facility based crisis and we have a 16hr max on it. i am no coder, but i don't think this bird will fly. was the patient in a facility and the MD called in....even so I think this code just can't be used as a telemedicine code.....

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4761
    • Solutions Medical Billing
Re: telephone calls and after hour service
« Reply #10 on: May 15, 2010, 08:44:39 PM »
The description I find is "crisis intervention mental health services, per hour".  It doesn't indicate facility, but it also doesn't indicate if the service has to be face to face, or if it can be telephone.

Michele
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

Pay_My_Claims

  • Guest
Re: telephone calls and after hour service
« Reply #11 on: May 15, 2010, 10:41:23 PM »
S9484 Professional Treatment Services in Facility-Based Crisis Programs

11. Professional Treatment Services in Facility-Based Crisis Programs Adults S9484
This existing service serves as an alternative to hospitalization for adults (age 21 and older) who
have mental illness/developmental disability/substance abuse disorder. It is a 24 hour residential
facility that provides support and crisis services in a community setting.
The services are provided
under the supervision of a physician with interventions implemented under the physician direction.
The purpose is to implement intensive treatment, behavioral management, interventions or
detoxification protocols to stabilize the immediate problems and to ensure the safety of the
individual. It is offered seven days/week and must be provided in a licensed facility. Medicaid
does not reimburse for room and board. Prior approval is required by the statewide vendor at the
end of eight hours if additional hours are needed.

This is a short-term service that does not exceed 15 days. This service cannot be billed for more
than a total of 30 days in a 12 month period.
This service is billed on an hourly basis and cannot exceed 16 units each day.


Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4761
    • Solutions Medical Billing
Re: telephone calls and after hour service
« Reply #12 on: May 16, 2010, 07:28:49 AM »
Charlene,

       Is your description from a HCPCS book?  Just curious, because my research didn't show the facility description, but I wasn't looking in the HCPCS book.

Michele
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

Pay_My_Claims

  • Guest
Re: telephone calls and after hour service
« Reply #13 on: May 16, 2010, 07:44:05 AM »
No, it isn't from the HCPCS coding book, it is the NC Medicaid billing guidelines for mental health billing.  but when i check other states its the same (for MEDICAID)

here is what SC states

Attention:  Enhanced Mental Health and Substance Abuse Service Providers
Professional Treatment Services in Facility Based Crisis Programs

Information published in Implementation Update #48 stated that Facility Based Crisis Programs could not be billed and reimbursed for adults under the age of 21 years old.  Through further advocacy with CMS, their decision was reversed, allowing Medicaid reimbursement for these services.  The implementation of this service expansion will occur as follows:

For Medicaid recipients age 18 through 20 years old, a new procedure code/modifier combination was implemented effective with date of service March 1, 2009.

    * Providers who are direct-enrolled can be reimbursed for services rendered by billing S9484 with modifier HA.
    * The rate of reimbursement for S9484 with modifier HA is $17.99 per unit (1 unit = 1 hour).
    * No more than 16 units can be billed and reimbursed per date of service.
    * No more than 480 units (30 days) can be billed and reimbursed within a calendar year.
    * All current policy applicable to S9484 with no modifier will apply to S9484 with modifier HA.

For Medicaid recipients age 21 years old and older, S9484 with no modifier should continue to be billed for reimbursement.

    * The rate of reimbursement for S9484 with no modifier will continue to be $17.99 per unit (1 unit = 1 hour).
    * No more than 16 units can be billed and reimbursed per date of service.
    * No more than 480 units (30 days) can be billed and reimbursed within a calendar year.
    * All current policy applicable to S9484 with no modifier remains in place.

The application of these separate procedure code/modifier combinations will allow DMA to assess the impact of the policy change.  The Service Definition Review Work Group convened by DMA and the Division of Mental Health, Developmental Disabilities and Substance Abuse Services will be asked to develop the endorsement and service definition criteria for Facility Based Crisis Program services specific to Medicaid recipients under age 18.  Further information will be communicated as this process unfolds.

For any questions concerning this change in billing procedures, please contact EDS Provider Services at 1-800-688-6696 or 919-851-8888.

Behavioral Health Services
DMA, 919-855-4290

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4761
    • Solutions Medical Billing
Re: telephone calls and after hour service
« Reply #14 on: May 16, 2010, 02:19:05 PM »
OK, my info came from Value Options.  I wonder if it's just Medicaid specific.  Thanks for the clarification.

Michele
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com