Author Topic: Mental Health Office with a new Licensed Chemical Dependancy Counselor HELP!  (Read 198 times)

JenniferPT

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We are a primarily mental health office.  All staff are LPC's or LMFT's.    Our owner hired a LCDC to treat substance abuse issues.    Had a new patient come in, see one of the LPC's.  She referred to the LCDC because the client had chemical dependency issues.  LCDC sees client, files claim, claim denied.  I'm guessing because there was no mental health Dx with the 90791 CPT code.   Owner told me to use the LPC's Dx in addition to the multiple Substance Abuse Dx codes the LCDC used.

I'm not comfortable with the legality of this.   But none of us know how to bill SA.   Ironically, not even the LCDC.    She just thinks the LPC's should do the Initial Eval and hand them over to her for substance abuse counseling.   I've asked her, "Do you know what kind of billing codes are to be used within the scope of your license?"   No clue. 

This is in an office setting.   I am refusing to touch these until they can figure it out, which hasn't happened in the last 2 weeks I've given to get me an answer.   

Anyone know what CPT codes a LCDC can use alone with their Substance Abuse Dx codes, without a mental health Dx?

PMRNC

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Is there a supervising physician on staff?? Who actually provided the initial eval?

The initial eval 90791 has to be done by an MD/DO, CSW or CP (Clinical psychologist), CNS, PA or NP. Also if they were seen on same day, carriers generally will not cover two services on same day with any of the mental health codes aside from testing.

I don't blame you for not touching the billing, it sounds as if the owner needs to hire experienced billing and/or coding staff. I think just knowing what CPT/HCPCS codes isn't going to be enough help. In addition many insurance carriers will still not cover LCDC's and requirements might go further to say a supervising physician needs to be present.

Not sure that helps at all but the 90791 isn't going to be payable under an LCDC or even the LPC
Linda Walker
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Jmojica

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SA uses HCPCS codes here in NY . I've never worked with a LCDC clinician in our SA clinic only CASAC (S)?

Michele

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I'm not sure what you are asking.  Are you asking if it's ok to use HCPCS codes?

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