Mental Health
1 / 40

Preventive Services Improvement Initiative - PowerPoint PPT Presentation

  • Uploaded on

Mental Health Diagnostic and Procedural Coding. Objective. To improve diagnostic and procedural coding for mental health screening, assessment, referral, and intervention. How Do Y ou D ocument M ental H ealth S ervices ?. Who documents mental health services?

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about 'Preventive Services Improvement Initiative' - Mercy

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

Mental Health

Diagnostic and Procedural Coding


To improve diagnostic and procedural coding for mental health screening, assessment, referral, and intervention

How do y ou d ocument m ental h ealth s ervices
How Do You Document Mental Health Services?

  • Who documents mental health services?

  • Where are mental health services documented? (mental health chart, medical record, both charts, log sheet, database, encounter form)

  • How do mental health providers and primary care providers share information about mental health services?

What we ll c over
What We’ll Cover…

  • Why code?

  • General Coding Principles

  • Mental Health Diagnostic Codes

  • Mental Health Procedural Codes

  • Reimbursement

    • Who can bill?

    • Fraud and Abuse

  • Work plan suggestions

Why code
Why Code?

We can t bill for mental health services so why code
“We can’t bill for mental health services, so why code?”

You should still document in order to:

  • Justify your position

  • Assess mental health problems of school population

  • Track treatment

  • Track compliance

  • Assist in measuring outcomes

  • Demonstrate a need for mental health reimbursement

Why code correctly
Why Code Correctly? code?”

  • Reimbursement depends on services described by CPT codes--coding is the basis for reimbursement

  • Diagnosis codes support medical necessity for services delivered

  • Understanding coding assumptions and guidelines helps providers to optimize reimbursement

  • Providers must establish integrity in the health care system

    • Document necessity services

    • Illustrate complexity of services

General coding principles1
General Coding Principles code?”

  • The purpose of codes is to document services provided

  • Documented services are likely to be paid

  • Services not documented “never happened”

  • Never “upcode” for the purpose of getting more money

  • Most likely, you are undercoding

General coding principles cont
General Coding code?”Principles (cont)

  • Two Part Coding Process

    • CPT – “What you do”

    • ICD – “Why you do it”

  • Diagnosis codes (ICD) must support procedure codes (CPT)

You must always

have both!

General coding principles cont1
General Coding code?”Principles (cont)

  • Primary Steps for Coding an Encounter:

    • Provider chooses procedure code (CPT) from encounter form or superbill

    • Provider notes diagnosis, which is matched to a diagnosis code (ICD)

Documentation code?”

Where to document codes?

  • Encounter Form

  • Database

    BOTH (if separate):

  • mental health chart AND

  • medical record

Coding systems
Coding Systems code?”

ICD-9-CM(International Classification of Diseases, Ninth Revision, Clinical Modification)

  • Used by health care professionals to classify patient illnesses, injuries, and risk factors

    *ICD-10 coming out in 2012

    DSM-IV-TR(Diagnostic and Statistical Manual – Fourth Edition – Text Revised)

  • Used by mental health clinicians to make a psychiatric diagnosis

    *DSV-V coming out in 2013

Anxiety disorders
Anxiety Disorders code?”

300.01 Panic Disorder Without Agoraphobia

300.21 Panic Disorder With


300.22 Agoraphobia Without History of Panic Disorder

300.29 Specific Phobia

Specify type: Animal Type/Natural Environment Type/Blood- Injection-Injury Type/Situational Type/Other Type

300.23 Social Phobia

Specify if Generalized

300.3 Obsessive-Compulsive Disorder

Specify if With Poor insight

309.81 Posttraumatic Stress Disorder

Specify if Acute/Chronic

Specify if With Delayed Onset

308.3 Acute Stress Disorder

300.02 Generalized Anxiety Disorder

300.00 Anxiety Disorder NOS

Depressive disorders
Depressive Disorders code?”

  • 296.xx Major Depressive Disorder

    • .2x Single Episode

    • .3x Recurrent

  • 300.4 Dysthymic Disorder

    Specify if Early Onset/Late Onset

    Specify With Atypical Features

  • 311 Depressive Disorder NOS

Disruptive behavior disorders
Disruptive Behavior Disorders code?”

  • 314.xx Attention-Deficit/Hyperactivity Disorder

    • .01 Combined Type

    • .00 Predominantly Inattentive Type

    • .01 Predominantly Hyperactive-Impulsive Type

  • 314.9 Attention-Deficit/Hyperactivity Disorder NOS

  • 312.xx Conduct Disorder

    • .81 Childhood-Onset Type

    • .82 Adolescent-Onset Type

    • .89 Unspecified Onset

  • 313.81 Oppositional Defiant Disorder

  • 312.9 Disruptive Behavior Disorder NOS

Substance abuse dependence
Substance Abuse/Dependence code?”

  • 303.90 Alcohol Dependence/305.00 Alcohol Abuse

  • 304.00 Amphetamine Dependence/305.70 Amphetamine Abuse

  • 304.30 Cannabis Dependence/305.20 Cannabis Abuse

  • 304.20 Cocaine Dependence/305.60 Cocaine Abuse

  • 304.50 Hallucinogen Dependence/305.30 Hallucinogen Abuse

  • 304.60 Inhalant Dependence/305.90 Inhalant Abuse

  • 305.1 Nicotine Dependence

  • 304.00 Opioid Dependence/305.50 Opioid Abuse

  • 304.60 Phencyclidine Dependence/305.90 Phencyclidine Abuse

  • 304.10 Sedative, Hypnotic, or Anxiolytic Dependence/305.40 Sedative, Hypnotic, or Anxiolytic Abuse

  • 304.80 Polysubstance Dependence

  • 304.90 Other (or Unknown) Substance Dependence

  • 305.90 Other (or Unknown) Substance Abuse

    The following specifiers apply to Substance Dependence as noted:

    With Psychological Dependence/Without Psychological Dependence

    Early Full Remission/Early Partial Remission/Sustained Full Remission/Sustained Partial Remission In a Contained Environment On Agonist Therapy

Documentation of diagnostic codes
Documentation of Diagnostic Codes code?”

  • Report the full ICD-9-CM code for the diagnosis shown to be chiefly responsible for the outpatient services.

  • Providers should report the diagnosis to their highest degree of certainty.

Coding systems1
Coding Systems code?”

  • CPT (Current Procedural Terminology) - codes that predominantly describe services & procedures.

  • They provide a common billing language that providers and payers can use for payment purposes

Evaluation management e m codes
Evaluation & Management (E&M) Codes code?”

  • 99201 – 99215 New and Established Patient Office Visits

  • 99241 - 99245 Consultations

  • 99361 - 99362 Case Management Services, Team Conferences

  • 99371 - 99373 Case Management Services, Telephonic

Mental health procedure codes
Mental Health Procedure Codes code?”

  • 90801 - 90802 Psychiatric Diagnostic or Evaluative Interview Procedures

  • 90804 - 90829 Psychotherapy

  • 90804 - 90815 Office or Other Outpatient Facility

  • 90810 - 90815 Interactive Psychotherapy

  • 90816 - 90829 Inpatient Hospital, Partial Hospital or Residential Care Facility

  • 90845 - 90857 Other Psychotherapy

  • 90862 - 90889 Other Psychiatric Services or Procedures

Psychiatric therapeutic procedures
Psychiatric Therapeutic Procedures code?”

  • CPT Codes 90804 – 90889

  • Psychotherapy is the treatment for mental illness and behavioral disturbances in which the clinician establishes a professional contract with the patient and, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development.

E m codes and mh codes
E&M Codes and MH Codes code?”

  • The Evaluation and Management services should not be reported separately, when reporting codes: 90805, 90807, 90809, 90811, 90813, 90815, 90817, 90819, 90822, 90824, 90827, 90829

Reimbursement code?”

  • Who can bill?

  • Fraud and Abuse

Who can bill
Who code?”Can Bill?

  • What are the rules governing who can bill for mental health diagnosis/treatment in your state?

Who can bill1
Who code?”Can Bill?

  • Who can bill for behavioral health services?

    • Most states accept physicians, Clinician Psychologists (CP), Licensed Clinical Social Workers (LCSW)

    • However, each State has its own rules and many will pay for other professionals

Coverage issues
Coverage Issues code?”

  • A provider should know what services are covered.

  • Services must be documented and medically necessary in order for payment to be made.

  • Do you, as a provider, know if all services provided are covered?

  • Are you documenting properly, and what about this “medically necessary” bit?

How much are you paid
How Much code?”Are You Paid?


  • Reductions in reimbursement rates by provider type

    • Physician - not discounted

    • Clinical Psychologist - discounted

    • LCSW - further discounted

    • Other - discounted if covered

Reimbursement issues
Reimbursement Issues code?”

  • E&M codes are limited to physicians, Pas, NPs, nurses

  • Same is true for 90805, 90807, 90809 codes

  • An E&M (992XX) and a therapy (908XX) cannot be billed on the same date of service to most Medicaid programs

Documentation and coding fraud and abuse
Documentation and Coding: code?”Fraud and Abuse

  • Services MUST be medically necessary (determined by payers based on a review of services billed)

  • Music, game, instrument, pet interaction therapies, sing-alongs, arts and crafts, and other similar activities should not be billed as group or individual activities.

  • Services performed by a non-licensed provider particularly as “incident to” using the PIN of the licensed provider

Elements of incident to
Elements of “Incident To” code?”

  • An integral part of the physician’s professional service

  • Commonly rendered without charge or generally not itemized separately in the physician’s bill

  • Of a type that are commonly furnished in physician’s office or clinic

  • Furnished under the physician’s direct personal supervision

Work plan suggestions
Work code?”Plan Suggestions

Action step review program services
Action code?”Step:Review Program Services

  • Define the Behavioral/Mental Health Services your students are receiving

  • Determine if there are additional Behavioral/Mental Health Services you want to provide

Action step review and modify encounter form
Action code?”Step:Review and Modify Encounter Form

  • Does encounter form include both diagnostic and procedural codes that would be used for behavioral health when delivered by primary care providers? Mental health providers?

  • Do procedural codes represent all services provided (including those not billed for)?

  • Do diagnostic codes represent all diagnostic categories (including those not billed for)?

Action step review and modify documentation procedures
Action code?”Step:Review and Modify Documentation Procedures

  • Are diagnostic and procedure codes documented for in each progress note?

  • Are codes for each encounter documented in both the SBHC medical record and mental health chart (if separate)?

  • Are codes entered into database regardless of reimbursement?

Action step understand state program and provider coverage issues
Action code?”Step:Understand State Program and Provider Coverage Issues

  • Research State Program Information

    • (Medicare Regulations)

    • Search by state by Department of Health or Department of Mental Health to find state specific information

  • Contact State Medicaid Assistance Program and determine specific Behavioral Health Service requirements

  • Invite Medicaid Representatives to your facility or visit them to present Behavioral Health Program and clearly understand the requirements

Questions to answer
Questions to Answer code?”

  • What criteria must programs (SBHC) meet in order to provide behavioral health services?

  • What providers are eligible to provide behavioral health services?

  • What are your state’s credentialing and licensing requirements for providers of behavioral health services?

  • What credentialing and licensing requirements are necessary for billing in your state?

  • What are the guidelines for billing services as “incident to?”

Action step determine reimbursement estimates
Action Step: code?”Determine Reimbursement Estimates

  • Obtain reimbursement rates by provider type for state and other programs

  • Understand billing rules by payer, e.g. billing E&M visit same day as Behavioral Health visit, number of visits limits, auth/pre-authorizations, etc.

  • Assure you have a complete understanding of program parameters re: Individual Therapy, Case Management, Special Behavioral Health Services, etc.