Billing > Billing
Counseling VS Substance Abuse Tx?
Christy:
Hi everyone,
I bill for a LMHC. She always bills 90791, 90834, 90853. She is in private practice. She sees people with addiction problems.
She will often ask me to check benefits for a patient's "mental health" as well as "substance abuse" benefits.
This confuses me, as won't billing the above codes means that the benefits would automatically fall into the "mental Health" category of benefits?
What are the codes for office based, private practice "substance abuse" treatment?
This is in New York State, in case that is relevant.
thanks so much!
rdmoore2003:
The cpt codes are correct. the benefits however go by the diagnosis codes, this is how it is determined.
ex: F43.12 chronic ptsd- (mental health) f12.20 cannabis with intoxication, uncomplicated (mental health still because of the provider- but this dx code is under substance abuse)
PMRNC:
I'm a bit confused by your question:
--- Quote ---This confuses me, as won't billing the above codes means that the benefits would automatically fall into the "mental Health" category of benefits?
What are the codes for office based, private practice "substance abuse" treatment?
This is in New York State, in case that is relevant.
--- End quote ---
You would bill whatever services/dx your given.. I'm not understanding your question really.
RichardP:
--- Quote from: PMRNC on January 26, 2016, 10:27:10 PM ---You would bill whatever services/dx your given.. I'm not understanding your question really.
--- End quote ---
Linda - I think your response to bill whatever services/dx your given.. contradicts both the reality of billing and previous comments you have made.
One of our clients writes down what he did and leaves it to his staff to find the correct code(s). If we think his staff has coded in error, we need to have a solid argument as to why we think this when we return the fee slip to the provider for more proper coding. This requires that we have more than a passing acquaintance with coding - even though we don't offer coding as a service.
Also - in previous discussions, you have presented convincing evidence that billers can be prosecuted for the fraud perpetrated by the provider because "the billers should have known better" or "the billers should have recognized the fraud being perpetrated by the provider". The underlying principle to both of those statements is that billers should be informed enough to recognize when a provider is not providing correct service/dx/cpt information to the biller. Again, billers being informed enough to catch errors (intentional or purposeful) perpetrated by the provider requires that billers have more than a passing acquaintance with coding.
I understand not wanting to do someone's job for them by providing codes to them that they should be getting from their provider. But hopefully my comments here make it clear that we can play a role in educating billers about coding so that they can more successfully catch errors (intentional or purposeful) made in the codes submitted to them with which they are to bill.
Michele:
I think the confusion is in calling to check benefits. Wondering why you would check benefits for mental health AND substance abuse. Thinking they are the same?
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