Recent content by ckeeney

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    90837 Behavioral health

    You can find the NCD/LCD coverage here: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57480 If the diagnosis is not on the NCD/LCD and it is correct per documentation, then there is no option of submitting a corrected claim.
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    Wiki Psychiatric E/M or Hospital Admission E/M?

    You are correct that you can't use both. We have a 16-bed psychiatric inpatient unit and not part of a large hospital system and our providers routinely use 99223 for the initial visit. They are also the attending. There are many scenarios to decide which code would be appropriate.
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    Wiki E/M 99214 code with add-on psychotherapy code 90833

    90833 add-on code would be used when there was psychotherapy done by the rendering provider in addition to the E&M service. There needs to be separately identified note with start and stop times indicated and this time does not count towards the E&M level (in fact, using MDM for the level is...
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    Wiki Psychiatrist Billing

    I would add that you need to check payer rules. Medicare, for example, does not allow billing under a supervising provider. Indiana Medicaid (the state I am billing for), has specific rules on supervising and modifiers for mental health services as well as who can be credentialed and bill. Most...
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    Wiki 90847 Couples/Family Counseling

    Although this is not specific to Noridian, I have the following from CMS: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57480 It lists 90847 and the covered diagnoses.
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    Wiki Inpatient Psychiatric coding information

    For an understanding of diagnoses I have access to the DSM-5 through our corporate enrollment with the publisher: https://dsm.psychiatryonline.org Although these do not always crosswalk to the ICD-10 options, it can give you a good understanding of the disorders. Our providers use DSM-5 when...
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    Wiki Inpatient Psychiatric coding information

    Check on your MAC's website. I find useful articles/training. What type of facility? I work for an entity that has it's own psychiatric inpatient unit POS 51.
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    Wiki Hosptialist Rounding at Behavioral Health Hospital

    What CPT and POS codes are being used for the hospitalists' rounds? The S9480 is for Intensive Outpatient services, per diem (and Medicare does not pay). I am curious about the use of the S9480 at this facility. Are your hospitalists doing medical (non-behavioral health) inpatient or outpatient...
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    Wiki BH Group Therapy

    I am not familiar with 99411/99412. What provider would be leading these groups? Is there a specific focus for these groups (substance abuse, mental health disorders)? As a behavioral health entity we use 90853 for all group therapy without regard to age categories. These are lead by therapists...
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    Wiki Billing for MSW interns...I'm so confused!

    Our state Medicaid is the only payer that allows us to bill for interns with an HL modifier using the supervising clinician as rendering (incident to). Does the intern have an MSW and is interning for CSW? We have many commercial payers that will allow us to bill an MSW as rendering. We can also...
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    Wiki TBI (S06.-) and Dementia (F02)

    Yes. My question has more to do with whether or not to code the TBI as subsequent treatment or sequela. With the F02 code dementia due to, the underlying cause must be coded first, thus the TBI. I am having problems with the guideline that states to code the sequela first then the TBI...
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    Wiki Medical necessity for Dx F31.70

    I checked the LCD for the Florida MAC and F31.70 is not covered for therapy services (https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57520). If this was an E&M service the LCD would not apply. It may be that the code states "in remission" which may not justify medical...
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    Wiki Assisted Living

    We bill these services as noted. I would look at the E&M guidelines in the CPT book. Starting 1/1/23 these services moved and follow the CPT guidelines for billing. If you are looking for information from AAPC, check the magazine articles at the beginning of last year when this update occurred...
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    Wiki TBI (S06.-) and Dementia (F02)

    I am in a dilemma. We are a behavioral health facility and often the medical condition documented as cause of the dementia is a (old) TBI. I interpreted the dementia as sequela/late effect, however although not specifically indicated as not a principal diagnosis, we have a payer who is...
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    Wiki Telehealth in Assisted Living and Home by Professional Provider

    I found this definition on the CMS website which I would interpret as meaning that assisted living is a private residence much like an apartment would be. ASSISTED LIVING A type of living arrangement in which personal care services such as meals, housekeeping, transportation, and assistance...
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