Wiki Behavioral Health Billing

[cyberenvoy1@comcast.net]

When a client comes in for their initial intake with the Therapist on the Same as their initial intake with ARNP or Doctor, do I use 99202 or 99203, 99203 etc. with a modifier 25 with the 90791 or 90792. I read the CPT guidelines just making sure I understand it correctly. I have to make quiet a few corrections on previous reports that were denied.

Also, is there a service code for a medical assistant who takes the patients vitals, demographic information, insurance information Commercial insurance or Medicaid insurances or do we still simply use 99202 with modifier 25 for example for Commercial insurance but not sure what to use for Medicaid Insurances.

Also, can I use H2017 services the same day as H2019 HO or HR? Do I need a modifier added to those services and if I do, which one? I really don't know!

I really hope my questions make sense. Please help!
Respectfully submitted,

 

[TThivierge]

Hi Cyber
You should use 90791 or 90792 FIRST assess pt mental health problem. Cannot bill all those CPT codes same time with same doc or therapist. See pg. 733 in CPT manual yr. 2023.The nurse code 99211 can be used by QHP. Do not put modifier 25 on CPT 99211. Does the pt see MD or p[sychistirst doctor first then given later to LCSW or LPC therapist same day? Each clinician should have own claim, documentation and assessments.
Well hope helped you
Lady T

 

[cinlop8737@gmail.com]

Hello, I am new to behavior health coding and billing. My question is how do go about billing/coding say a nurse visit 99214 and the TMS 90867. I am being told that patients are wanting to see there nurse the same day as the are getting there TMS or the 99417. Do we just add the mod 25?

 

[TThivierge]

Hi Cinlop
You cannot use CPT 99214 unless licensed doctor status . Do not use modifier 25 on CPT 9211 for nurse ,even if nurse does injections. The nurse can only use CPT 99211 if face to face or( HCPCS T1001-T1003 used by state Medicaid agencies only) nurse assessment but document vitals, & reason pt coming in. Add attending doc to claim for the nurse's claim for established patients. If pt given phone call document minutes on record and need at least 5 or 15 minutes for phone. Add plan of care, vitals and assessment .Etc by nurse. Also if do phone call using CPT 98966-98967 for nurses and QHP staff. Lic docs use CPT 99441-99442 for phone calls . Mental Health providers(LCPS LCSW) can use CPT 90832-90837 add modifier 93 if phone. Check with commercials payers see if accept telephone calls for staff and you can send a claim for just RN.
If pt see nurse code & bill it...if not see nurse fac e 2 face I 'd not bill just list as clinical history note.
I hope this data helps you
Lady T

 

[ckeeney]

Hello, I am new to behavior health coding and billing. My question is how do go about billing/coding say a nurse visit 99214 and the TMS 90867. I am being told that patients are wanting to see there nurse the same day as the are getting there TMS or the 99417. Do we just add the mod 25?

Is the nurse visit 99214 for an APN/NP? Then they would have to meet the E&M criteria and billed per payer requirements for rendering provider.
With regards to same day services and, in particular, TMS there is this note in the CPT book:
"If a significant, separately identifiable evaluation and management, medication management, or psychotherapy service is performed, the appropriate E/M or psychotherapy code may be reported in addition to 90867-90869. Evaluation and management activities directly related to cortical mapping, motor threshold determination, delivery and management of TMS are not separately reported."

So, the question is what was done in the 99214 and if not related then it is billable as noted above. If two separate providers were involved, one did the E&M and another for the TMS, I would recommend separate claims each under their own rendering provider NPI. This is assuming billing on 1500's for professional services.