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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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    Wiki Telehealth in Assisted Living and Home by Professional Provider

    Assisted Living services were moved to the Home services category for E&M billing and the description for POS 10 from CMS is: The location where health services and health related services are provided or received, through telecommunication technology. Patient is located in their home (which is...
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    Wiki Spanish Interpreting services

    I have never seen a code for interpreter services. Providing them is required under Title VI of the Civil Rights act. If someone has guidance otherwise it would be interesting to hear. I know this question has come up several times in the Forum, you might want to search for older posts on this...
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    Wiki Counseling and Co Insurance

    We do not collect anything at time of service. We send out monthly statements to clients.
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    Wiki Psych Coding

    Hello, at one point (prior to the E&M updates in 2021) a 90792 should follow the rules for a 99215: in other words a Comprehensive History, Comprehensive Exam, and Assessment and Treatment Plan. The history and exam were to follow the 97 E&M specialty guidelines for psychiatry and, if not met...
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    Wiki Psych Coding

    Assuming this is a medical provider these notes read like E&M services. Although therapy is mentioned you would have to look at the guidelines to bill an E&M and add-on therapy code. "For the purposes of reporting, the medical and psychotherapeutic components of the service may be separately...
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    Wiki Behavioral Health Billing

    Is the nurse visit 99214 for an APN/NP? Then they would have to meet the E&M criteria and billed per payer requirements for rendering provider. With regards to same day services and, in particular, TMS there is this note in the CPT book: "If a significant, separately identifiable evaluation and...
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    Wiki ARNP Mental Health Billing

    It depends in part on your state ARNP scope of practice rules as well as payer rules. In the state where the entity I bill for is located we have a number of ARNP's with a Mental Health certification on staff. They are credentialed under their own NPI and we bill their services as rendering...
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    Wiki E&M coding

    Go to the source: https://www.ama-assn.org/practice-management/cpt/implementing-cpt-evaluation-and-management-em-revisions There are a number of videos, learning modules. You can set up a free account to access these; you do not need to become a member of the AMA.
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    Wiki Billing 99214, 90833 and 90868 on the same day

    You may need to appeal with documentation: For 90868 there is this note in the CPT guidelines "(If a significant, separately identifiable evaluation and management, medication management, or psychotherapy service is performed, the appropriate E/M or psychotherapy code may be reported in addition...
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    Wiki Medicare new rule for telehealth initial intake in person before telehealth can be used

    From the MLN901705 Fact Sheet dated June 2023 for Telehealth Services: "● Through December 31, 2024: ○ For behavioral or mental telehealth, you don’t have to conduct an in-person visit within 6 months of the initial telehealth visit or annually thereafter○ "
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    Wiki Telehealth Group Therapy with E/M

    We would bill this separately E&M on one claim under rendering medical provider and Group Tx on separate claim following payer rules (sometimes under rendering such as LADAC; others require supervising with provider level modifier (AJ, HE, etc)). We are a psychiatric center billing as outpatient...
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    Wiki Modifier 25 or 95

    In the second example 99213 - 25 +90833: Was therapy done by the same provider? The +90833 is an add-on code to be used when the same provider does both the med management and psychotherapy; no -25 modifier is needed when it is an add-on code. If the therapy services are being billed as...
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    Wiki Medicaid out-of-pocket question

    Just a note on Medicaid. Medicare is an entirely Federal program and sets nationwide regulations. Medicaid is a joint program between the Federal government and the states. States must follow some rather broad guidelines but there is much discretionary area for state regulation. That is why each...
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    Wiki 90792 and 90832

    This from the guidelines in the CPT book (highlighting mine): Codes 90791, 90792 are used for the diagnostic assessment(s) or reassessment(s), if required, and do not include psychotherapeutic services. Psychotherapy services, including for crisis, may not be reported on the same day.
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    Wiki 99214 With E/M Codes

    I just wanted to add that when billing E&M visits using time in the behavioral health world, any psychotherapy provided during the same visit is not included in the time for the E&M but rather needs to be separately documented and the add-on psychotherapy codes used. Times for both services need...
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    Wiki Coding help oral/dental

    I code for a psychiatric inpatient unit and had the following medical issue during a patient's stay. Mucous membranes moist, poor dentition, first upper molar on R with significant decay and pus visible. Edema on Right cheek extending to under R eye, no erythema, no ecchymoses. No x-rays done...
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    Wiki Psychiatrist Billing

    Complicated question. Some payers allow LCSW, for example, to bill under their own name/credentials. In this case, no modifier. Our state Medicaid requires for mid-levels to be credentialed or bill under supervising with modifier. As far as time: our MD's do not usually do therapy...
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    Wiki Psychiatrist Billing

    I code and bill for a mental health entity and a psychiatrist should use the E&M codes for med management visits. If they also do psychotherapy as part of the visit, it must be separately documented and billed with psychotherapy add-on codes. Our psychiatrists rarely do therapy, only med...
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    Wiki Help with Diagnosis Coding

    Yes, I thought about the R44.- codes rather than the F06.0 The provider states in the note: " ... who is experiencing visual and tactile hallucinations after second back surgery. Most likely has a psychotic disorder due to a known physiological disorder, status post back surgery, recurrent...
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    Wiki Help with Diagnosis Coding

    I need some input on how to code the following: Patient was seen by a psychiatrist for audio and tactile hallucinations. Reported principal diagnosis by the provider is F06.0 - Psychotic disorder with hallucinations due to known physiologic condition. For the underlying conditions the provider...
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    Wiki 99214 and 90832

    We bill both services on the same day when one provider is a psychiatrist or NP for the 99214 and the therapy 90832 bills under the therapist (HSPP, LCSW or similar). No 25 or 59 modifiers and separate claims. Our state Medicaid also allows us to bill the therapy under the supervising...
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    Wiki Crisis Services

    We are a community mental health center and there is a project to operate walk-in crisis intervention centers. Are there any thoughts about H2011 vs. 90839? We know that Medicare does not pay for H2011 (generally, only Medicaid will). We are also aware of different provider level restrictions on...
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    Wiki Provider POS for telehealth after PE ends

    Thank you
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    Wiki Inpatient/Observation Same Date Admission/Discharge

    With the revisions in 2023 the codes for same day admission and discharge show a revised description: ▶The following codes are used to report hospital inpatient or observation care services provided to patients admitted and discharged on the same date of service. For patients admitted to...
    • ckeeney
    • Thread
    • Replies: 0
    • Forum: E/M
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    Wiki Provider POS for telehealth after PE ends

    Is this in the same document? I didn't see it. What is your source for this? Thank you.
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    Wiki Medical Translator

    There is also this: https://www.hhs.gov/civil-rights/for-providers/laws-regulations-guidance/guidance-federal-financial-assistance-title-vi/index.html
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    Bilingual Is Important !

    Yes, I have a family member who is a clinical psychologist in Colombia and she was kind enough to provide me with an electronic copy of the ICD11 in use there.
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    Bilingual Is Important !

    I am bilingual in English (primary language) and Spanish and I have found it useful in the many different positions that I have held. I would specifically mention that in a role as medical biller/accounts receivable specialist I was able to communicate with Medicare HMO representatives in Puerto...
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    Wiki 90791/90792 Evaluation as Opposed to Outpatient 99205

    From the guidelines "Codes 90791, 90792 may be reported once per day and not on the same day as an evaluation and management service performed by the same individual for the same patient." I would understand this to allow 90791 performed by a therapist as long as the rendering provider is not...
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    Wiki Office visit E/M (MAT) and behavioral health coding

    We have MAT physicians and therapists billing for services on the same day. We do separate claims: the E&M for the MAT physician on one claim and the therapist's service on a separate claim that, depending on the payer, may be billed under either the supervising physician with the appropriate...
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    Wiki CPC-A seeking medical coding experience in Seattle, WA or remote

    If you do not have a chapter affiliation yet check out the Everett Chapter. Or post this to the Local Chapter forum for Everett. If you do not have a chapter affiliation yet check out the Everett Chapter. They also have a Facebook page with some job postings. Or post this to the Local Chapter...
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    Wiki Mailing Patient Statements

    Your EMR company may also be able to help you set up electronic claim filing although they may want you to use a specific clearinghouse they have a business relationship with. I started out when paper claims were the norm and lived through the transition to all electronic filing. Nowadays the...
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    Wiki Home and Nursing Facility Services

    I have been reviewing the 2023 guidelines for the recently updated E&M services and had some questions. We are a specialist group that has been providing services to rest home, assisted living, group home, etc facilities. Some of these services may now fall into the nursing facility category. I...
    • ckeeney
    • Thread
    • Replies: 1
    • Forum: E/M
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    Wiki Hardest and most important skill in billing?

    As a billing manager I want someone who learns quickly (and realizes that in healthcare the learning never stops) and is extremely detail-oriented. Because so much of the billing function is automated, as noted previously, a biller works the exceptions. They must be able to problem solve why a...
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    Wiki 2023 E/M Guidance

    I have been searching in the new CPT book and on the AMA as well as this site and I can't seem to find an answer: under the new guidelines for IP/Observation and Home services will the overall MDM level be determined by meeting and/or exceeding all 3 categories or 2 out of 3? Anybody have a...
    • ckeeney
    • Thread
    • Replies: 1
    • Forum: E/M
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