Wiki In search of help with Psych billing

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GregPress

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Hello all,

I recently started working for a Psych/Neurology clinic and could use some advice and help with my questions. Please, if time allows, contact me if you are familiar with the nuances of this type of work. I am new to all of this and the clinic just opened.

You can contact me via message on here or by phone....

enjoy the day!

Thanks!
Greg Press
479.387.0818 -cell
 
Yes, psychiatrist office. One provider now....growing in the fall.

She just opened a new clinic. Still being credentialed with major payers. Between the M.D., office manager and myself, we dont have any experience with billing for mental health, but are motivated to figure it all out. What are some pysch specific billing related issues we should be prepared for? I have only worked in a family practice clinic...

Thanks,
Greg
 
Hi, Greg. I'm the assistant clinic manager of Fairbanks Psych and Neuro and have been here for going on fourteen years, doing billing, coding etc. I would be happy to help with any issues I can. The most important thing I can think of off hand is pre-authorizations. Payers still carve out psych benefits from medical and have managed benefits. Some, like Fed. Blue Cross require pre-auth for the initial visit and X number of follow-ups, then will want a treatment plan. We always tell our psych patients to check with their insurance first because there are often higher co-pays for mental health. Med management normally does not require pre-auth with any payers but it's good to check. Feel free to contact me if you need any help. Good luck. Psych is never dull.
 
hello, Davis. I would like to know what to do about outpatient psychiatric services (90804-90809)provided for visits that are 50-75 minutes. I see there are 45-50, 75-80, but what about the inbetween? Do you just round down? Thanks for you input.
 
Hi Greg,

I do have some experience in Mental Health and Neuro / Neuropsych billing. I'd be happy to help where I can. The best thing I could recommend is to get your hands on a copy of the APA's CPT Handbook for Psychiatrists. It's pretty helpful in getting your mind around the services, what the documentation should look like, and some of the Medicare requirements.

For your question above regarding time, yes, you would have to round down if you did not meet the threshold for the next service. For example, if your provider documented that they spent 60 minutes with the patient you would be limited to the 45-50 minute service as you didn't meet the minimum 75 minutes for the next level.

Hope this helps!
 
Mod 22?

would you also apply the modifier 22 for increased services since the 60 minute time is over the 50 minute maximum time length for the code?
 
Can someone help me, I am doing Psych billing for a large therapy group. We had a large audit with Tricare and was told to not bill the base code with every date of service. We bill the base code at the first visit CPT 96132, after we bill 96136 and 96137 for testing each day the patient comes in. Tricare is not paying us for any testing codes 96136 and 96137 unless we bill the base code with each one. Has anyone every had this problem?
 
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