behavioral health

  1. A

    Billing IOP for Medicare Patients

    Does anyone have any tips for getting Medicare to Reimburse for Intensive Outpatient Programs (IOP)? I've been reading and looking over guidelines and I can't find anything useful. To make matters complicated, I believe my organization is technically in the process of getting credentialed now as...
  2. buskeys

    Question Behavioral Health and Psych Resources

    Hi! Does anyone have any good Behavioral Health and/or Psychiatry resources for coders? Whether that be books, manuals, articles, papers etc. Thanks :)
  3. A

    Extended Group therapy Code?

    Hello, I just started a new job at a Behavioral Health Organization. I have been trying to help them improve upon their coding. One thing I haven't been able to find, is a good code to use for 2 hour group therapy session. It is not family members, groups are around 10 people, and they are...
  4. R

    Question Adolescent Residential billing for MH and SUD

    I need help. I have been billing for adults my whole career, but now have some questions regrading adolescents. This would be for residential care at a residential facility. Primary dx will usually be MH, and I cannot find any specific information on if billing will even change from what I am...
  5. C

    Question Billing for Case Management (98966-98968)

    Hello. I am new to billing for Behavioral Health and I want to make sure I'm doing so correctly. Any help to lead me in the right direction is appreciated so, thank you in advance! I have a therapist that sent me a message for me to bill "Case Management via Telephone" for a patient. When...
  6. A

    Question bill psychotherapy codes before assessment?

    The behavioral health providers at our clinic asked me how many times they can bill 90832 psychotherapy before an assessment 90791 is required. They think that they can bill up to 4 sessions before they complete an assessment. I cannot find any coding/billing information to support this idea...
  7. E

    Question 90971/90972 vs 9920x

    I am new to behavioral health, and I want to know when the appropriate times are to use these codes. I work on a college campus, so our providers are sometimes the first psychologists and psychiatrists to treat a client (and do the diagnosing). In that instance, the providers (psychiatrists) are...
  8. M

    Behavioral Health Job Openings - Compliance Specialist and Payment Integrity Manager

    Large Behavioral Health Payer looking for experienced candidates (at least 2-3 years) with excellent analytical skills and experience dealing with large data files, behavioral health coding/billing compliance experience for all lines of business (Medicare, Medicaid, Commercial). Advanced Excel...
  9. R

    Substance TX and Private Insurance Billing

    I bill for a group practice that is fairly new to private insurance. Our main payer is state medicaid. I am having a hard time trying to get info on how to bill private insurances when services are rendered under a certified addiction counselor...the state of Maryland acknowledges CAC's but most...
  10. M

    Coding Help for ABA-Autism Billing

    Can anyone help me with a billing/coding question in regards to ABA services, codes 0364T and 0365T? I need to know what the guideline/rules are for billing the secondary code 0365T, as far as the times/rounding up? What is the guideline, for billing the secondary code and rounding up? Does it...
  11. J

    Wiki Primary Payor Determination - HELP! BH Offices and Beyond

    I need some help please. I am working with some Behavioral Health Offices that are having some issues determining Primary Payors. I am looking for a chart or decision tree or anything that will not only look at Medicare vs Group Health but all payors. Because more often than not we are billing...
  12. S

    Behavioral Health billing to Medicare Part B

    When billing for BH services- intake and ongoing- where do you find the code sets used for Medicare part B in Arizona? I submitted an H0031 and it was denied. Does anyone have any information to share with me, please, any help or guidance would be greatly appreciated. This is a new area in our...
  13. J

    BH Assessments - ER Diagnosis Codes

    I code for BH and I receive BH assessments (completed by LSCSW) in the ER. I am having issues with the diagnosis coding. On one hand there are the diagnoses, signs, and symptoms the patient (or outside source) reports. On another hand the LSCSW reports different (or the same) diagnoses in the...
  14. J

    Behavioral health coding- help!

    Hello coding world, I am a brand new coder and took a position as the only coder/biller at a small counselors office. So, I don't have anyone above me to help with my questions. The question is regarding Arizona Medicaid and the correct code for services. The HCPCS code for a drug and/or...
  15. J

    Group- Substance/Alcohol Abuse

    I am in Arizona and bill for a counselors office. I am wondering which code to use for a group therapy that is for substance and/or alcohol abuse. It is an intensive outpatient therapy but not all of the patients attending the group sessions meet the HCPCS requirement for the group (H0015; which...
  16. R

    New to Behavioral Health

    Does anyone have any good resources (books,websites,guidelines,etc) that they find useful when coding for Behavioral Health? Our clinic just recently brought on two Behavioral Health providers and I would appreciate any and all recommendations on coding for Behavioral Health as this will be a...
  17. S

    Lcsw credentialing

    I'm VERY new to behavioral health coding/credentialing. Does ANYONE have any helpful tips/resources I could utilize in making this transition easier? Also, they want me to credential a LCSW (licensed clinical social worker) is it the same as a Dr/PhD or different?
  18. B

    Therapeutic Youth Group Home Coding/Billing

    I work for a Mental Health Center, and we also have several Therapeutic Youth Group Homes. We bill S5145 to Medicaid for the group home services, which is what our state requires. However, they have also been trying to bill this code to all the private insurance companies for families that have...
  19. G

    DSMV crossover to ICD10 Help!

    Hello all, I am having trouble choosing the appropriate ICD10 code for the following DSMV: Major Neurocognitive Disorder due to Traumatic Brain Injury, with behavioral disturbance. Any suggestions? The closest I can find is F02.81, but that lists dementia and the provider does not like this...
  20. A

    Billing H0023 for Medicaid

    I am wanting to know if you could use H0023 more than once for a member specifically if you were trying to engage them. For example: you had an open group (non-billable) to provide education, support, etc. but it is not designated for established clients in an agency. What if a person comes more...
  21. T

    Billing 96152

    We are an FQHC in Arizona. We have an LCSW. We need to bill 9615x codes but keep getting denied saying a modifier is missing. Example: T1015 FQHC Visit 96152 Health and Behavioral intervention, each 15 minutes, face-to-face, individual Anyone know what modifier we would use? Thanks, Theresa...
  22. S

    Advice on best book to have on hand for Behavioral Health coding & Billing

    Just started Billing & Coding for a Behavioral Health Center and wanted to see if anyone had suggestions on the best book & or tools to have on hand. I looked through AAPC, but wanted any and all opinions. Thank you for any and all help!!!
  23. H

    Time Requirement for H2010

    Hello, Can you bill less than 15 minutes using H2010? I know it says per 15 minutes. However, I know there are some CPT's out there if you provide services for at least 8 minutes you can use the code. Any assistance would be greatly appreciated! Thank you! Heather
  24. H

    Time Requirement for H2010

    Hello, Can you bill less than 15 minutes using H2010? I know it says per 15 minutes. However, I know there are some CPT's out there if you provide services for at least 8 minutes you can use the code. Any assistance would be greatly appreciated! Thank you! Heather
  25. C

    Grant funding vs Using insurance

    Hello, I work for a nonprofit mental health center that accepts insurance but is largely funded by grants. I am having a hard time getting straight answers from our contracted payors (insurance companies) so I am looking for some guidance to balance grant funding for services where the client...
  26. J

    BH cheat sheets / Decision Trees

    I am taking on a new practice in need of some assistance for old 2016 claims and forward. Does anyone out there by chance have any cheat sheets, audit tools or training materials that they can share? It has been a few years since I have done Behavioral Health and would appreciate any assistance.
  27. C

    Poisoning Codes - need clairification please

    Maryland Value Options Medicaid (Behavioral Health) will cover poisoning codes in categories T36-T50; however, not all codes. Is it correct to assume that those codes in T36-T50 ending with 5 or 6 (adverse effect and underdosing) are not poisoning codes? We need to flag the poisoning T36-T50...
  28. 0

    Searching for CPT: Cogmed Working Memory Training

    I have been searching for the most appropriate code for Cogmed Working Memory Training. It consists of using a computer (in part) for cognitive therapy. This therapy is sometimes used after TBI; however, it has been used to treat other conditions such as ADHD. The program is 25 sessions that...
  29. A

    Behavioral Health in-home

    Does anyone have any experience or knowledge as to whether psychotherapy (codes 90791-90834-90837-90846 provided by LCPC/LCSW) can be reimbursed if the visit took place in home? It appears that Medicare will reimburse for POS 12 for LCSW but I can't find any clarity on other license levels or...
  30. K

    Residential Treatment and DCS Contracts

    I work for a mental health facility that has a contract with DCS as a residential treatment facility. We have a building for Level 2 and Level 3 patients. If they are in the state's custody, Level 3 clients' services are only billed to DCS. If they have private insurance, Level 3 client's...
  31. T

    Coding Behavioral Health Forms

    I am requesting opinions regarding what information from specific areas should be coded from Behavioral Health visit forms. Informational areas on the form are: Mental status, Medical symptoms (medical condition, medication, physical symptoms), Behavioral history, Substance use, eating habits...
  32. C

    Help with Psych ICD-9 Sequencing & COnsults

    I am a coding compliance auditor (no boos, please!) and I have recently inherited a psychiatry group. I have absolutely no experience with psych coding at all, and the availablity of any resources on the subject are positively underwhelming! I have 1 main question: Our psychiatrists do a lot...
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