Understanding Psychotherapy for Crisis Coding

A guide to securing provider reimbursement for codes G0017 and G0018.

The Centers for Medicare & Medicaid Services (CMS) introduced new HCPCS Level II codes G0017 and G0018 for psychotherapy for crisis services effective Jan. 1, 2024. The codes provide appropriate reimbursement for care related to urgent mental health crises furnished in non-facility settings. This article aims to provide medical coders and billers with a comprehensive understanding of these codes, their application, and billing guidelines, making it easier to ensure accurate processing and payment of claims for these essential services.

Background and Rationale

The introduction of codes G0017 and G0018 was driven by the need to improve access to mental health crisis services and ensure that providers are adequately compensated for delivering these critical services. The Consolidated Appropriations Act (CAA), 2023 played a significant role in this change, recognizing the importance of timely and effective crisis intervention. These new codes are designed to address the gap in reimbursement for crisis services provided in non-facility settings, which were previously billed with CPT® codes 90839 and 90840.

Overview of G0017 and G0018

G0017 Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); first 60 minutes

This code covers the first 31-74 minutes of psychotherapy for crisis services provided in a non-facility setting, excluding the office setting. This follows the CPT® midpoint rule of timed services. It is designed for patients experiencing a mental health crisis that necessitates immediate attention. The code may only be used once per date.

G0018 Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); each additional 30 minutes (list separately in addition to code for primary service)

This code is used for reporting each additional 30 minutes of psychotherapy for crisis services provided in a non-facility setting, excluding the office setting. It must be billed in conjunction with the primary service code G0017. It may be reported once an additional 16 minutes is spent, following the midpoint rule.

Application and Use

The G0017 and G0018 codes are designed for patients experiencing high distress with life-threatening, complex problems requiring immediate intervention. These services include an urgent assessment and history of the crisis state, a mental status exam, and a disposition plan. The primary goal is to stabilize the patient and develop a plan for follow-up care.

Billing guidelines:

Eligibility: Only qualified mental health professionals, such as licensed clinical social workers, psychologists, and licensed professional counselors, may bill for these services.
Place of service: These services must be provided in a non-facility setting, such as a patient’s home, a community center, or a school, that is not the office setting. The place of service codes should be accurately reported on the claim form to reflect the location where the services were rendered. Accurate place of service coding is crucial for proper reimbursement and compliance with CMS guidelines.
Reimbursement: The payment for G0017 and G0018 services is 150 percent of the fee schedule amount for non-facility sites of service. This increased reimbursement rate reflects the urgent nature of the services provided and the need for immediate intervention. Understanding the reimbursement structure is essential for accurate billing and ensuring that providers are compensated appropriately for their work.
Documentation: Proper documentation is essential to support the medical necessity of the services. This includes detailed notes on the patient’s mental health crisis, the assessment conducted, and the disposition plan. The presenting problem is often life-threatening or complex, demanding urgent care and attention to a patient experiencing severe distress.

Place of Service Codes

When billing for G0017 and G0018 services, it is crucial to use the correct place of service (POS) codes to indicate where the services were rendered. Some relevant POS codes that represent non-facility settings include:

03: School
04: Homeless shelter
09: Prison/correctional facility
10: Telehealth provided in patient’s home
12: Home
13: Assisted living facility
14: Group home
33: Custodial care facility

The psychotherapy in crisis codes cannot be used in the office setting (POS 11).

Scenario 1: Crisis Intervention at Home

A patient experiences a severe mental health crisis at home. The patient exhibits signs of severe anxiety and potential self-harm, necessitating immediate intervention. A licensed clinical social worker arrives at the patient’s home and begins the assessment.

The social worker conducts an urgent assessment, including a detailed history of the crisis, a mental status exam, and initial interventions to stabilize the patient. The session includes calming techniques and the creation of a safety plan. The social worker also contacts the police and an ambulance for transportation of the patient to a behavioral health facility and continues with interventions until transportation is completed.
The social worker spent and documented 80 minutes of time devoted directly to the patient. Documentation also includes details of the assessment, intervention, mental status exam, safety plan, and disposition.
In this scenario, POS 12 would be used. Codes G0017 and G0018 x 1 would be billed.

Scenario 2: Crisis Intervention in a School Setting

In a school setting, a student has a severe emotional outburst, exhibiting signs of acute distress and potential harm to self or others. A licensed professional counselor intervenes.

The counselor performs a crisis assessment, including a history of the student’s current emotional state, a mental status exam, and immediate crisis management strategies. The goal is to deescalate the situation and ensure the student’s safety. The session includes contacting the student’s guardians, coordinating with school officials, and developing a comprehensive follow-up plan. Detailed notes support the extended care provided and a total time of 120 minutes.
In this scenario, POS 03 would be used. Codes G0017 and G0018 x 2 would be billed.

Documentation Best Practices

Documentation should be thorough, accurate, and reflective of the care provided to justify the use of these codes and support reimbursement. Elements to include:

Detailed assessment: Include a thorough assessment of the patient’s crisis state, including specific details such as the duration of the crisis, precipitating factors, and the patient’s immediate needs. This helps justify the use of crisis codes.
Mental status exam: Document the findings of the mental status exam, including observations of the patient’s appearance, behavior, speech, mood, affect, thought processes, and cognitive functions. This provides a comprehensive picture of the patient’s mental health.
Disposition plan: Clearly outline the disposition plan, including immediate interventions, safety plans, follow-up appointments, and any referrals to other healthcare providers. This demonstrates a comprehensive approach to crisis management.
Time spent: Accurately document the total time spent face-to-face with the patient and/or family on crisis intervention services. Time does not have to be continuous but must be time fully devoted to care of this patient and not include time spent providing services to other patients. The patient must be present for all or some of the service. Time documentation is critical for appropriate billing and reimbursement.
Patient and family involvement: Note any involvement of the patient and their family or caregivers in the assessment and planning process. This highlights the collaborative approach to managing the crisis and ensures that all relevant parties are informed and involved.

Common Challenges and Solutions

Psychotherapy in crisis services pose several challenges for coders:

Incomplete documentation: One of the most common challenges is incomplete documentation. To address this, ensure that all aspects of the crisis intervention, including the assessment, mental status exam, and disposition plan, are thoroughly documented. Use checklists or templates to standardize documentation workflow.
Incorrect POS coding: Always verify the POS codes to ensure they accurately reflect where the services were provided.
Time documentation: Accurately documenting the time spent on crisis intervention can be challenging. Use a time in/time out log, a timer, or time-stamped notes. Electronic health record systems with built-in timers may also be helpful to determine the time spent. Continuing education on best-practice workflow habits will help to ensure precise time documentation.
Coordination with other providers: Coordinating care with other healthcare providers can be complex. Maintain clear communication and documentation of any referrals, consultations, or collaborations with other providers or community resources involved in the patient’s care.

Crisis Averted

The introduction of G0017 and G0018 codes represents a significant advancement in the reimbursement of psychotherapy for crisis services. By understanding the application, billing guidelines, and documentation requirements, medical coders and billers can ensure accurate and efficient processing of claims for these essential services. Proper use of these codes not only ensures appropriate reimbursement but also supports the delivery of timely and effective mental healthcare to patients in crisis.

Author:

Elizabeth Herbert, RHIA, CPC, CDEO, CPB, CPMA, CPMS, CRC, RCMS, CCC, AAPC Approved Instructor, has over 25 years of experience in a variety of healthcare roles: coding/billing, education, CDI, medical assisting, and pharmacy. She is a current Epic application analyst with Baptist Healthcare System in Kentuckiana. She also works as an AAPC virtual instructor and subject matter expert on AAPC’s Subject Matter Advisory Committee and enjoys volunteering her time to speak on favorite coding topics, including vascular, cardiovascular, risk adjustment, and E/M. LinkedIn: https://www.linkedin.com/in/eherbert-cpc