Our first fee schedule reduction with new psych codes

December 28, 2012, 6:41 pm

≫ Next: MDs 90791 vs 90792

≪ Previous: Are you prepared for 2013?

$

0

0

On August 22, 2012, I posted this:  Expect reimbursements to drop.

United has sent out fee schedules, and for PhD's (psychologists), the fees have been reduced.  The people working on the CPT code changes have always said it was to better describe the services rendered (separating out the work for MDs vs. PhDs and others); I have always said it was to reduce payments for non-MDs. 

What is amusing in a stick-a-needle-in-your-eye sort of way is that the new codes for psychotherapy (which are a code-only change and not a description change and were rarely if ever billed by MDs), saw their reimbursements drop also.

Sometimes, I hate it when I'm right.

---

MDs 90791 vs 90792

January 2, 2013, 10:32 pm

≫ Next: No add-on code for use of interpreter

≪ Previous: Our first fee schedule reduction with new psych codes

$

0

0

Can anyone explain why the insurance companies are paying (alot) less for 90792s than 90791s? 90792s seem like they should be priced higher because of the meds component? Seems like Ins companies are certainly using this event to effectively renegotiate contracts as our 90792 rates are being set lower than our old 90801s.

In lieu of this, can MDs just bill 90791s instead or are reduced rates or E/M new patient codes the only option?

thanks

No add-on code for use of interpreter

January 7, 2013, 5:16 pm

≫ Next: Psych ER Billing Question

≪ Previous: MDs 90791 vs 90792

$

0

0

The new year brought new CPT codes for mental health.  One of the codes, 90785, is for "interactive complexity" and can only be used in conjunction with another code.  The CPT book says this code is to be used to indicate a more difficult session, not a longer session.  You must meet one of four criteria to use this code: maladaptive communication, caregiver impediment to treatment plan, mandated reporting situations, or use of play equipment or interpreter.

Medicare has stated that you CANNOT use this add-on code solely for the use of an interpreter, despite what the CPT book says.  Here is why: 

Medicare patients pay a copay based on a percentage of the allowed amount.  By charging more for the use of an interpreter, a patient would have a higher copay, which means you are violating federal law that prohibits discrimination on the basis of ethnicity.  While someone may eventually argue the...

Psych ER Billing Question

January 7, 2013, 5:55 pm

≫ Next: Consult Code

≪ Previous: No add-on code for use of interpreter

$

0

0

A patient enters the ER - psychiatrist bills a 90801; the psychiatrists are on 12 hr shifts; next shift patient is still in the ER psychiatrist bills 99284; sometimes the patient can remain in the ER and the next psychiatrist bills 99284 or patient is admitted and admitting psychiatrist bills 99223

This doesn't seem correct to me.  Suggestions - insight appreciated.

Thanks.

Consult Code

January 16, 2013, 3:43 am

≫ Next: How to apply an AJ Modifier

≪ Previous: Psych ER Billing Question

$

0

0

Last year we rec'd many rejection on hospital consultation / follow up for our physicians. They rec'd call from Psych department for consultation. Psychiatric physician has Auth # & in-network. But as per hospital rule, other internal medicine physician must see same patient for non-psych issues. Some time they called Neurologist too. But for us, no auth # & we are non-par for psych department. We got lots of rejection. Only few are paid with first psych diagnosis. Example ....If Insurance is Humana, they forward the claim at their psych department @ Psychcare in Miami. Psychcare denied for medical claim & no auth. Humana denied for Psych claims. We are rejected by both department. We like to find the solution..Any suggestions??
How to bill Non-Psych Physician @ Psych Insurance Company???

How to apply an AJ Modifier

January 17, 2013, 6:41 pm

≫ Next: Billing Issues with the new 2013 CPT Codes

≪ Previous: Consult Code

$

0

0

I billed the 90834 to Medicare for a LCSW. (Date of service was 1-2-2013) The claim was rejected and when I called the cust service rep told me that "I needed an AJ Modifier" since the service was provided by a Clinical Social Worker. (In the past I have been billing 90801 and 90806 for the same provider and Medicare, or any other insurance, has never asked for this.)

What is the purpose of a modifier? What is an AJ Modifier? I use Helper Software and I can see a place to add a three digit modifier code but what is the code?

All advice is very much appreciated. Thanks in advance.

Billing Issues with the new 2013 CPT Codes

January 18, 2013, 4:19 pm

≫ Next: E Prescribe

≪ Previous: How to apply an AJ Modifier

$

0

0

Is anyone having issues with billing or reimbursement on the new 90837 psychotherapy code?  My docs usually always see the client for 60 minutes.  In the past they would bill 90806 45-50 minute but the new code of 90837 actually represents the time they are spending with the patient.  The crosswalk shows code 90834 should replace the 90806 but they rarely see the patient for 45 minutes.  I've heard some carriers are considering the 90837 as "extended time" and aren't wanting the docs to use this code frequently.  Any input from other billers would be great!

E Prescribe

January 21, 2013, 6:23 pm

≫ Next: New procedure for clinician?

≪ Previous: Billing Issues with the new 2013 CPT Codes

$

0

0

I am wondering if any one is using any of the free E Prescribe software out there and how they are working out for them? Our Psychiatrist wants to start using it so we are penalized but I am not sure what ones are good.

---

New procedure for clinician?

January 21, 2013, 6:28 pm

≫ Next: Setting Rates For New Psychiatric Codes

≪ Previous: E Prescribe

$

0

0

I am wondering if anyone is billing for these services? One of our clinicans found this online and wants to know who is qualified to bill for this care. The information below states : "The CPT guidelines include specific services by the physician or other healthcare professional included in TCM"

Transitional care management services

Code 99495 (transitional care management services) requires the following elements:

Setting Rates For New Psychiatric Codes

January 25, 2013, 5:10 pm

≫ Next: Dual Psychotherapy

≪ Previous: New procedure for clinician?

$

0

0

Hello All. I have been billing for the same psychiatrists for about 6 years. With the same software. It was already set up prior to me coming to this office. So all the rates and charges for each procedure were already in the system. Now with the ...
Read More

Dual Psychotherapy

February 13, 2013, 7:59 pm

≫ Next: Assigning codes to MDs and psychotherapists sessions

≪ Previous: Setting Rates For New Psychiatric Codes

$

0

0

Has anyone had the situation of two related patients seen by both of their therapists in the same session?  Can both therapists bill the services for their own client and what code would be most appropriate?

Assigning codes to MDs and psychotherapists sessions

February 19, 2013, 3:32 am

≫ Next: New to Psychiatry Billing - Question about Units

≪ Previous: Dual Psychotherapy

$

0

0

We are a psychaitry practice with five MDs and three therapists, and I am incharge of billing. With the new 2013 CPT codes I passed the responsibility of assigning the codes to the providers (both MDs and therapists). For MDs there is no way I can co...
Read More

New to Psychiatry Billing - Question about Units

February 27, 2013, 2:58 pm

≫ Next: Beacon Health Strategies

≪ Previous: Assigning codes to MDs and psychotherapists sessions

$

0

0

Hello.  I have been billing for MedLegals for a short time, and have just started billing for psychotherapy.  My question: how do you calculate units for 90791 and 90834?  For a MedLegal, 1 hour = 60 units.  Is it the same for psychotherapy codes or i...
Read More

Beacon Health Strategies

February 27, 2013, 4:24 pm

≫ Next: US DEPT OF LABOR - FEDERAL WORK COMP AND MENTAL HEALTH

≪ Previous: New to Psychiatry Billing - Question about Units

$

0

0

Has anyone worked with Beacon Health Strategies? We have been invited to join their network. (We are based in Illinois.)

The network is for Dually Eligible (Medicare and Medicaid) beneficiaries and is an Integrated Health Plan tha...
Read More

US DEPT OF LABOR - FEDERAL WORK COMP AND MENTAL HEALTH

March 1, 2013, 7:44 pm

≫ Next: HELP with CPT coding for psychotherapy

≪ Previous: Beacon Health Strategies

$

0

0

In January 2013, when we used new psych codes, our claims were denied with "invalid CPT code."  I spoke to a rep from the US DOL, and she said that the fee schedule is not updated until July 1, so we are to continue to use the old codes until then.&n...
Read More

---

HELP with CPT coding for psychotherapy

April 1, 2013, 11:25 pm

≫ Next: billing groups correctly

≪ Previous: US DEPT OF LABOR - FEDERAL WORK COMP AND MENTAL HEALTH

$

0

0

Hi!! I work for a Psychiatric NP. I am the office manager and haven't ever had formal training with coding. I think that I have figured out most of the new CPT changes, but I am confused on one.  A patient that we have only comes in for a 50 min psychoth...
Read More

billing groups correctly

April 6, 2013, 2:20 pm

≫ Next: Psychiatric Claims Rejection

≪ Previous: HELP with CPT coding for psychotherapy

$

0

0

I have not been reinbursed for more than one group per day. We use 90853 and have tried to put 3 units and been denied. Is there a modifier code for two services on one day? Medicaid won't tell me.

Psychiatric Claims Rejection

May 21, 2013, 3:09 am

≫ Next: How do I bill EMDR with a 1 hour 30 minute session?

≪ Previous: billing groups correctly

$

0

0

Hi, I'm writing in-line with my previous question, I need more clarification.We bill for non psychiatric provider who does H and P in the Psychiatric ward(Unit).  Hospital gets Auth # for Psychiatric provider, that not good for medical provider. I want...
Read More

How do I bill EMDR with a 1 hour 30 minute session?

June 2, 2013, 8:00 pm

≫ Next: Neuropsych Billing help

≪ Previous: Psychiatric Claims Rejection

$

0

0

How do I bill EMDR with 90 minute protocol? I have a new client, MSW LICSW, who utilizes EMDR over a 1 hour and 30 minute session. How should this be coded and billed?Thank you!

Neuropsych Billing help

June 4, 2013, 5:56 pm

≫ Next: Psychotherapist saw patient in the hospital

≪ Previous: How do I bill EMDR with a 1 hour 30 minute session?

$

0

0

I just graduated from college for medical billing & claims analysis and I got a job in a mental/behavioral health practice. In school they just teach you the general billing process. One of our established patients just gave me new insurance informati...
Read More