Sherry Marchand – Coding and Billing for Mental Health Services 2018 Code Updates: CPT, ICD, DSM-5, and HCPCS Level II Code

Outline

CPT/HCPCS PROCEDURE CODES

• New charts by program of most common used CPT/HCPCS level II codes
• Codes for diagnostic assessments
• Codes and guidelines for psychotherapy
• Codes and guidelines for psychotherapy with E/M
• Codes and guidelines for psychotherapy for crisis
• How to code medication management, use of evaluation, and management codes
• Code and guidelines for interactive complexity
• Group therapy
• Family therapy
• Health and behavior assessment/intervention services
• How to code and document psychological testing
• How and when to code evaluation and management services
• History, exam, and medical decision making vs. billing based on time
• How to code RN/LPN services

DIAGNOSTIC CODING

• 2018 code changes and online tools to prepare for ICD-10-CM
• DSM-5 structure
• DSM-5 diagnostic criteria for initial evaluations and treatment plans

FEDERAL REGULATIONS AND MEDICARE’S BILLING RULES

• Explore free online tools for access to federal and payer rules
• Affordable Care Act changes that impact mental health
• Fines have doubled in the False Claims Settlement Practice Act

COMPLIANCE WITH CODING AND DOCUMENTATION STANDARDS

• Gain systematic steps for implementation of new DSM-5 for diagnostic criteria medical necessity
• CMS MAC, RAC, ZIP, and CERT program guidelines
• OIG audit focus on behavioral health services
• Insurance companies and the focus on audits for psychiatric, psychological, and evaluation and management (E/M) services
• Medicare’s “incident to” guidelines
• Definition of “incident to” services
• Supervision requirements
• Documentation of initial assessments and treatment plans
• Components necessary in psychotherapy documentation and progress notes
• Common problem areas of documentation

UNDERSTANDING THE REIMBURSEMENT PROCESS

• Coding for maximum reimbursement by payer type
• Links to major payer websites: Medicare, Medicaid, Blue Cross/Blue Shield, and other payers
• Payment methodologies, PPS, and fee schedules

PROVIDER TYPES AND SCOPE OF COVERED SERVICES

• Psychiatrists
• Physician Assistants
• Certified Registered Nurse Practitioner
• Psychologists
• Social Workers
• Psychotherapists
• Professional Counselors
• Marriage and Family Therapists
• Outpatient clinic and hospital
• Consultation definition and appropriate use
• Inpatient hospital
• Partial hospital program
• Nursing facility
• Discharge day management

CLAIMS PROCESSING

• CMS1500
• UB-04
• Modifiers

THE APPEAL PROCESS

• Systematic steps of the appeal
• Understanding reasons for denials