Author Topic: 2013 mental health codes  (Read 16793 times)

PMRNC

  • Hero Member
  • *****
  • Posts: 4254
    • One Stop Resources & Networking for Medical Billers
Re: 2013 mental health codes
« Reply #30 on: December 19, 2012, 12:05:06 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.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4770
    • Solutions Medical Billing
Re: 2013 mental health codes
« Reply #31 on: December 21, 2012, 09:49:18 AM »
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!
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

PMRNC

  • Hero Member
  • *****
  • Posts: 4254
    • One Stop Resources & Networking for Medical Billers
Re: 2013 mental health codes
« Reply #32 on: December 21, 2012, 10:57:55 AM »
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 :)
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

ledwards

  • Newbie
  • *
  • Posts: 6
Re: 2013 mental health codes
« Reply #33 on: January 02, 2013, 11:54:06 AM »
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???

PMRNC

  • Hero Member
  • *****
  • Posts: 4254
    • One Stop Resources & Networking for Medical Billers
Re: 2013 mental health codes
« Reply #34 on: January 02, 2013, 12:56:51 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. 
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Angie

  • Jr. Member
  • **
  • Posts: 98
Re: 2013 mental health codes
« Reply #35 on: January 02, 2013, 02:51:00 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!

PMRNC

  • Hero Member
  • *****
  • Posts: 4254
    • One Stop Resources & Networking for Medical Billers
Re: 2013 mental health codes
« Reply #36 on: January 02, 2013, 03:42:44 PM »
Quote
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.
« Last Edit: January 02, 2013, 03:44:51 PM by PMRNC »
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Angie

  • Jr. Member
  • **
  • Posts: 98
Re: 2013 mental health codes
« Reply #37 on: January 03, 2013, 04:15:32 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?

PMRNC

  • Hero Member
  • *****
  • Posts: 4254
    • One Stop Resources & Networking for Medical Billers
Re: 2013 mental health codes
« Reply #38 on: January 04, 2013, 09:44:24 AM »
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)
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

wbh

  • Newbie
  • *
  • Posts: 1
Re: 2013 mental health codes
« Reply #39 on: January 04, 2013, 05:50:40 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?

PMRNC

  • Hero Member
  • *****
  • Posts: 4254
    • One Stop Resources & Networking for Medical Billers
Re: 2013 mental health codes
« Reply #40 on: January 05, 2013, 11:10:36 AM »
Quote
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.

Quote
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.

Quote
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.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Buglet10

  • Newbie
  • *
  • Posts: 26
Re: 2013 mental health codes
« Reply #41 on: March 07, 2013, 11:50:19 AM »
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.

Coffeecat21

  • Newbie
  • *
  • Posts: 4
Re: 2013 mental health codes
« Reply #42 on: February 17, 2015, 03:38:52 PM »
How do I code a 1/2 session (25min.) for 90847?  There are no time ranges for family therapy w/patient.

PMRNC

  • Hero Member
  • *****
  • Posts: 4254
    • One Stop Resources & Networking for Medical Billers
Re: 2013 mental health codes
« Reply #43 on: February 17, 2015, 03:48:13 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.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

rdmoore2003

  • Hero Member
  • *****
  • Posts: 625
  • Live Life and Love God
Re: 2013 mental health codes
« Reply #44 on: February 17, 2015, 04:48:48 PM »
90832 Code shows a range from 16-37 minutes.   
Regina