Author Topic: Mental Health coding and add on  (Read 1410 times)

Carol

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Mental Health coding and add on
« on: May 15, 2012, 09:34:58 AM »
Would anyone well versed in mental health coding, know if 99050 & 99058 can be used as an add on for 90806 and like codes?

I recently interviewed with a mental health provider who is thinking of implementing an immediate care to the patients.  He stated that there had been eight times over the past few months that the office is done with hours, but a mental health professional is still there charting, call backs, etc., and will see the patient who requires immediate care.

Now of course I know that all plans do not reimburse the after hours, but I come from family practice and urgent care where we do get reimbursed by a good amount of carriers.

I am just curious if this is a viable option for psychotherapy.

Thanks in advance, for the help.

PMRNC

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Re: Mental Health coding and add on
« Reply #1 on: May 15, 2012, 12:17:34 PM »
A psychiatrist can charge the appropriate E/M code when applicable and documented. Therapists and non physicians cannot. Also carries will not pay for them in ADDITION to the therapy codes. Many carriers will still require authorizations so that's the time to ask when you call for benefits and authorization.   
Linda Walker
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Carol

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Re: Mental Health coding and add on
« Reply #2 on: May 15, 2012, 03:08:11 PM »
Thank you for the response, I appreciate it.

We are in NJ, and he is a psychiatrist and happens to have a large patient base that does not utilize the mental health care management plans, especially for the patients who fall under the MHPA.  Since their diagnosis is treated as any other illness, for the most part there are not limitations.

As I stated earlier, the family practice and urgent care that I do, we are reimbursed for the add on coding, as much as $50 for the 99050, but the general reimbursement is $30 in addition to the e/m.

Thanks again.

Carol


PMRNC

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Re: Mental Health coding and add on
« Reply #3 on: May 15, 2012, 04:37:52 PM »
Most of my clients are in NJ. My psychiatrist's that have extended visits utilize the E/M code's instead of the therapy codes but only when they of course document all elements of the E/M visit.   The urgent care facilities are indeed different than a mental health provider and I know even BCBS is no longer paying 99050, 99053 & 99058 to Urgent Cares since last year.   I would also guess that the diagnosis will have an impact on reimbursement to justify the after hours visit.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Carol

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Re: Mental Health coding and add on
« Reply #4 on: May 15, 2012, 08:06:03 PM »
You know what, I live in NJ, and the UC and FP are NY.  My mistake.  The psychiatrist that I interviewed with is in NJ.

However, we are contracted with Empire BCBSNY and are reimbursed for the 99050 per our negotiated contract.  (After 5:PM and all day on the weekends.)  Of course the home plan may deny as not a covered benefit under the patient contract, but the claim is usually adjusted by the local plan per our negotiated contract. 

My own Horizon BCBSNJ policy does reimburse my personal FP on the 99050, but in my geographical area it is less than what Empire BCBS reimburses to for the FP.  Having worked in contract development for the Blues, any employer can add or remove any given benefit when negotiating their provider contract. 

My thought was if it is eligible perhaps he should inquire.  He sent me an email and said that he is going to speak with his provider relations rep and contract development department.  He is also an attorney as is his wife and very hands on with all areas of his practice and I am sure he will not rest until he gets an answer.

Thanks again and enjoy the evening.