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Psychotherapy Billing

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					  Coding and Compliance Training

Review and Test for Mental Health Clinicians
   Being Credentialed by UNC Hospitals
               2004-2005



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Course Objectives


The purpose of this course and its follow-on
test is to provide clinical psychologists
and clinical social workers who are being
credentialed by UNC Hospitals, with
important information on three issues…
     Course Objectives

1.   Why compliance is important to you and your
     practice.

2.   Keys to correctly coding Psychological Services

       -Diagnostic Interviews and Therapeutic Services

3.   Billing Mental Health Services

       -Directly billing services to Medicare, Medicaid and
       Commercial Payors.
1. Why compliance is important to
you and your practice.
  Reimbursement

Providing good care while billing accurately
and confidently requires:
      Doing only what is medically necessary
      Documenting what you do
      Billing what you document
      Performing only services within your scope of
       practice
Understanding and applying coding and compliance
conventions can improve the level of reimbursement
for UNC P&A practices as well as the quality of the
medical record documentation.
 Why Compliance
 Beginning in December, 1995 the University of
  Pennsylvania, Thomas Jefferson, Pittsburgh, UT San
  Antonio, South Carolina, Virginia, the U Cal System,
  Chicago and seven or eight other schools of medicine
  have paid fines and penalties ranging from $2M to
  $30M.

 The University of Washington recently underwent a
  criminal investigation resulting in $24M in legal defense
  fees and an additional $35M in refunds & penalties.

 Since July 2002 , there have been at least two whistle
  blower faculty practice settlements and in January
  2003, the Cleveland Clinic settled with Medicare for
  $4M.
2. Keys to correctly coding Services:
   Diagnostic Interviews and
   Therapeutic Procedures
    Choose type of Psychiatric Services

   Psychiatric Diagnostic Interview
   Individual office/outpatient psychiatric
    therapeutic services (time-based)
   Other psychotherapy services
       Group settings

   Other psychiatric services/procedures
       Psychological tests (96100)
    Psychiatric Diagnostic Interview Codes

    CPT 90801 - Diagnostic Interview Exams
     include:
    1. Complete medical (including past, family, social)
        and psychiatric history
    2. Examine a complete mental status exam
    3. Evaluating the patient’s willingness & ability to
        work to solve mental problem
    4. Establishment of a tentative diagnosis

    Note: Information may be obtained from patient, other
       providers, or family
    Psychiatric Diagnostic Interview Codes             (cont’d)



     CPT 90802 – Interactive Diagnostic
      Interview Exams:
     1. Includes same components as 90801
     2. Exam is performed using non-verbal
        communication, such as toys or other inanimate
        objects
     3. Medicare covers 90802 for children 16 years of age
        or younger and adults who have lost
        receptive/expressive language communication
        skills. If the patient is incapable of communication
        by any means this code may not be billed.
    Psychiatric therapeutic services

   CPT Codes 90804-90815
   Psychotherapy (PsychoTx) is the
    treatment for psychiatric conditions in which
    the clinician establishes a professional
    contract with the patient, and through
    therapeutic communication, attempts to
    alleviate maladaptive behavior or emotional
    distress, and encourage personal growth and
    development. - CPT , American Medical Association
 Psychiatric therapeutic procedures   (cont’d)




Billing Outpatient PsychoTx:
   Codes 90804-90814 are billed based
    on face-to-face time with patient
    (see table on Slide 18 )
 Psychiatric therapeutic procedures     (cont’d)




Billing Outpatient PsychoTx:
   Clinical psychologists/social workers
    are not permitted to bill evaluation
    and management services. The
    following codes may not be billed
    directly or “incident to”:
        90805, 90807, 90809, 90811,
         90813, 90815
Billing Psychotherapy Codes
Choosing the appropriate code is based on:
1.   Type of psychotherapy
          Insight Oriented, Behavior Modifying and/or
           Supportive Psychotherapy
               OR
          Interactive psychotherapy
2.   Place of service (office/outpatient vs.
     inpatient)
3.   Face-to-face time spent with patient during
     psychotherapy
Defining types of Psychotherapy

    Therapeutic procedures are divided
     into 2 broad categories:
    1.   Interactive Psychotherapy
    2.   Insight Oriented, Behavior Modifying
         and/or Supportive Psychotherapy
 Defining types of Psychotherapy       (cont’d)



1.   Interactive Psychotherapy – use of play
     equipment, language interpreter,
     physical devices or other non-verbal
     communication
Defining types of Psychotherapy              (cont’d)


2.   Insight Oriented, Behavior Modifying and/or
     Supportive Psychotherapy:
        Insight Oriented – development of insight
         or affective understanding
        Behavior Modifying – use of behavior
         modification techniques and cognitive
         theory
        Supportive Psychotherapy – supportive,
         reflective interactions and cognitive
         discussions of reality
  Billing Psychotherapy Codes
        Office/Outpatient Setting

CPT Code     Type of Therapy                        Time
90804        Insight Oriented, Behavior Modifying
             and/or Supportive PsychoTx
                                                    20-30 min
90806        Insight Oriented, Behavior Modifying
             and/or Supportive PsychoTx
                                                    45-50 min
90808        Insight Oriented, Behavior Modifying
             and/or Supportive PsychoTx
                                                    75-80 min
90810        Interactive Psychotherapy
                                                    20-30 min
90812        Interactive Psychotherapy
                                                    45-50 min
90814        Interactive Psychotherapy
                                                    75-80 min
  Billing Psychotherapy Codes
        Inpatient/Residential Care Setting

CPT Code     Type of Therapy                        Time
90816        Insight Oriented, Behavior Modifying
             and/or Supportive PsychoTx
                                                    20-30 min
90818        Insight Oriented, Behavior Modifying
             and/or Supportive PsychoTx
                                                    45-50 min
90821        Insight Oriented, Behavior Modifying
             and/or Supportive PsychoTx
                                                    75-80 min
90823        Interactive Psychotherapy
                                                    20-30 min
90826        Interactive Psychotherapy
                                                    45-50 min
90828        Interactive Psychotherapy
                                                    75-80 min
    Billing Psychotherapy Codes

Medicare does not cover these services if:
   An evaluation and management code is billed
    by a psychiatrist on the same day, excluding
    consultations.
   Documentation indicates that dementia has
    caused significant cognitive deficiency to
    prohibit establishing a therapeutic relationship.
   Patient suffers from profound mental
    retardation.
      Documenting Psychotherapy

   Clinic note must include the method of
    therapy administered to patient (insight,
    behavior or supportive psychotherapy).
   You must indicate the amount of time spent
    in face-to-face therapy with patient

Note: 90808,90814,90821,90828 (75-80 minutes)
Require the documentation of medical necessity
and describe exceptional circumstances to be
billed to Medicare.
        Other PsychoTx Codes (90845-90857)

CPT     Patient/Group Description   Type of Therapy

90846   Family PsychoTx without     Insight Oriented, Behavior Modifying
        patient                     and/or Supportive PsychoTx
90847   Family PsychoTx with        Insight Oriented, Behavior Modifying
        patient involvement         and/or Supportive PsychoTx

90849   Multiple-family group       Insight Oriented, Behavior Modifying
        (generally not covered by   and/or Supportive PsychoTx
        Medicare)
90853   Group PsychoTx, excluding Insight Oriented, Behavior Modifying
        multiple-family           and/or Supportive PsychoTx

90857   Group PsychoTx, excluding Interactive Psychotherapy
        multiple-family
    Other PsychoTx Codes
A note on documentation:
   For Family Psychotherapies, with or without
    the patient present, the medical necessity
    and goals of treatment must be documented
    (e.g., “need to observe patient interaction
    with family members…”). See LMRP 6442
    (http://www.cignamedicare.com/partb/lmrp_
    lcd/nc/cms_fu/96-26.html)
     Additional Psychiatric Services
    Clinical psychologists and social workers may also
    bill for Personality Assessments:
    CPT 96100 – Psychological testing with
     interpretation and report (includes assessment of
     personality, psychopathology, emotionality and
     intellectual abilities, e.g., Rorschach or MMPI).

    Documentation must indicate the presence of mental
     illness or symptoms for which psychological testing
     is indicated as an aid in the diagnosis and
     therapeutic planning. The record must show the
     tests performed, scoring and interpretation, as well
     as the time involved.
      Where To Get Help


   www.med.unc.edu/compliance/

   UNC P&A Professional Coder, Psychology
      Michelle Scurlock, 966-2023

   School of Medicine Compliance Office 843-8638
      Charles Foskey, Compliance Officer
      Chris Carreiro, Office Manager
      Heather Scott, CPC, Compliance Auditor
      Wendy Smith, CPC, Compliance Auditor

   Confidential Help Line 800-362-2921

   2005 AMA CPT Manual (see Michelle Scurlock)

				
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