Mental health services are crucial today as they support our well-being. Considering the progress in handling mental health conditions. It is wonderful to see how far we have come now that the subject is being talked about and managed in a promising way!
For Mental Health Awareness, we discuss efficient mental health billing to prevent denials.
With increasing related cases, treatment methods are advancing. We will try to go through them step-by-step and break them down for you, starting from some basic ones.
For the very first interaction with the patient, we have some options to go through. Your choice of service depends on various factors, including:
Internal medicine M.D.s or nurse practitioners assessing patients for behavioral health. They may evaluate the patient or refer to a specialist for billing purposes:
Office Visit: 99202-99215
Inpatient Visit: 99221-99233
(*Or any other related POS- E/M like Home, domiciliary Assisted Living, etc.)
So, these E/M would be somewhere to start.
Remember, E/Ms include the history, exam, and MDM. Only CMS-approved practitioners like Psychologists & Social Workers can bill standard E/M codes. The rule of thumb is if you can manage medication or prescriptions, you can bill E/M services.
Annual Depression Screening: G0444
This one is billed once annually with AWVs only as a preventive measure. This is your typical Depression Inventory using a standard test for scoring.
Brief emotional and behavioral assessments performed with standardized instruments: 96127 (GAD-7 or PHQ-9)
This next step initiates treatment and defines the patient's diagnosis. Two ‘Units’ might be billed on the same day with or without the visit for each screening. Codes Z13.31 and Z13.39 are used for depression and mental health screenings. A total of 4 units of the services might be billable per year to most payers. For AWVs, diagnosis codes Z00.00 or Z00.01 for normal or abnormal findings are more suitable
Other similar codes that include assessment and intervention for a health risk analysis:
96156 is for health behavior assessment or re-assessment.
96158 Health behavior intervention, individual, face-to-face; initial 30 minutes
Intervention improves the patient's psychological and psychosocial well-being. The CPT codes 96156, 96158, 96159, 96164, 96165, 96167, and 96168 may be used only by a Clinical Psychologist (CP). The primary diagnosis must include ICD-10 CM code(s) for the treated physical condition(s).
96160 is for administering and scoring a standardized patient health risk assessment.
The provider administers a health risk questionnaire and analyzes, scores, and documents the results. Use this code for each standardized survey questionnaire.
This is where things start to get interesting. As, at this point, we are beyond the standardized tests and tools now. The provider interviews the patient to diagnose through biopsychosocial assessment.
Psychiatric Diagnostic Evaluation – without any medical services: 90791
Psychiatric Diagnostic Evaluation – with medical services: 90792
Prescription of medication or coordination of medications as part of medical care. Order/review of medical diagnostic studies – Lab, imaging, and other diagnostic studies. Psy.D and LCSWs bill 90791 based on the general rule.
90785 is an add-on code for communication difficulties during psychiatric procedures. Add-on codes may only be reported in conjunction with other codes and never alone. Specific communication difficulties are present with patients who typically:
Don't report 90785 with crisis codes or E/M if there is no psychotherapy.
Treatment Options – Psychotherapy
All roads (might) lead here! Accurate assessments lead to psychotherapy sessions with a licensed professional.
Psychotherapy codes are time-based codes that may be billed with or without the E/M codes
Psychotherapy billed without E/Ms
Psychotherapy billed with E/Ms
Managing behavioral health patients can be streamlined for improved efficiency. Use evaluation tools that adhere to payer requirements and billing guidelines. Following the step-by-step process is key for unique patient diagnosis. Detailed documentation helps payers understand patient progress and aids claim reimbursement.
AltuMED Medical Billing Solution is one of the five star rated Medical Billing Companies in Michigan, USA. Contact us for a detailed demo of our Medical Billing Services.
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