Maximizing Reimbursement in Today’s Fee for Service World

Part 2: The Codes

Mary Jean Mork, LCSWOctober 27, 2014Series offered through the support of the Maine Health Access Foundation

Objectives:The Codes

Participants will be able to: Describe the mental health and Health and Behavior codes

generally used by integrated clinicians Identify how the codes are accepted by various payers Identify key questions for reimbursement

Disclaimer for the series: This information does not represent how a payer might

respond to a claim This information does not replace any regulatory

information Always seek information from your own agency consultants

regarding any billing and coding practices

I have these great staff but:Who can get reimbursed for services in medical

practices?

Masters level cliniciansPsychologists

NPs/PAs

Master Level Clinicians

Medicare - LCSWs only, and only the mental health codes

Medicaid differs state to state and may allow: LCSWs, LCPCs and LMFTs, as well as conditional. May vary by practice type.

Commercials may also differ but generally more inclusive

Psychologists

Medicare reimburses both mental health and Health and Behavior codes

Generally paid by Medicaid and Commercial insurers

Psych NPs/PAs

Need to follow rules for E/M codes Generally paid by all payers Would probably not bill Health and

Behavior codes Often confusion around “medical” vs.

“behavioral” credentialing with the commercial insurers

We are working with patients with medical

conditions: What codes should we

use?Mental Health codes

Health and Behavior codesE/M codes

Mental Health and Health and Behavior Codes

Mental Health Codes 90791: Initial

Assessment 90832, 90834, 90837:

Individual Therapy 90846, 90847:Family

Therapy 90853: Group Therapy

Health and Behavior codes 96150: Assessment 96151: Reassessment 96152: Individual

intervention 96153: Group intervention 96154:Family intervention

E/M codes and Psych NPs

90832, Psychotherapy with E/M, 30 mins (16-37)

90834, Psychotherapy with E/M, 45 mins (38-52)

90837, Psychotherapy with E/M, 60 mins (53 or more)

90791, Psychiatric Diagnostic (Dx) Eval.

90792, Psych Dx Eval. with medical services

90791 + 90785, Psych Dx Eval. with interactive complexity

90792 + 90785, Psych Dx Eval. with medical services and interactive complexity

Health & Behavior (H&B) Codes 96150 – 96155

Reimbursement Resources

Medicare Links http://www.cms.gov/Manuals/IOM/list.asp http://www.cms.gov/Transmittals/01_overview.asp Medicare Documentation Guidelines for Evaluation and

Managements Services 95 & 97 http://www.cms.gov/MLNEdWebGuide/25_EMDOC.asp

NHIC http://www.medicarenhic.com/ CMS National Correct Coding Initiativehttp://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/

index.html/nationalcorrectcodinited Other www.mehaf.org – Maine Health Access Foundation www.ibhp.org – Integrated Behavioral Health Project www.mainehealth.org/behavioralhealthintegration www.thenationalcouncil.org – the National Council for

Community Behavioral Healthcare

Contacts

Mary Jean Mork, LCSWProgram DirectorMaineHealth and Maine Behavioral Healthcare110 Free St.Portland, Maine 04101

morkm@mmc.org, 207-662-2490