Wiki Inpatient Substance Abuse

[laylaykali]

I was just hired on as a CPC for an Inpatient Substance abuse treatment facility with locations in 4 different states. They also do outpatient treatment for adolescents. I'm trying to code for they're initial Psych Evals and then subsequent medical progress notes for the adult inpatients. For the Psych Eval w/out medical I've been using 90791, and then 99231-99233 for the medical progress notes for days after. But then there's HCPC.... am I using these correctly? Or should I be using HCPC? Please feel free to ask me more questions to clarify etc

 

[TThivierge]

Hi Laylaykali,
It seems you are doing this correctly with CPT 90791 and inpt psych codes 99231 -99233, but no idea of HCPCS to use in that setting. Understand MD, PA, DO psychiatrist and psychologist can bill for it. Psychologists should have separate education in medications some do not. Psych docs can bill for just about anything but especial medication management whereas LCSW and LPC cannot bill for that process CPT 90792. Understand differ in remission vs history of in Beh Health Dx codes. Hopefully docs and therapists are mentioning date in regards to the psych pts past mental health hospitalizations or problems. Also most payers will accept CPT 90791 for one time for each different dx type pt treated for in the year. So if pt. comes in for dx F32 one time can use CPT 90791 but if pt. returns to use again the CPT 90791 must be a differ mental health problem. In other words CPT 90791 can be used one time on one dx problem for the year. The payers only pay for this CPT 90791 one time a year UNLESS each different illness/problem.. Here are some other tips ...Use dx F90 for children not adults , use F53 and O99.35 if pregnant mom depressed and postpartum , watch out for Excludes 1 Rules but your Encoder system should warn you a bit about that situation. If clinician documented can add dx R44-R46 if applicable. Use those Z codes lastly on claim if apply to the documentation...Z63, Z86.5 Z39, Z13.31, Z02.83(first listed Z code dx) and Z04.39 and Z13.31.
Good luck! Also Goggle the billing issue this helps your understanding too. They have websites of psych billing and read the Healthcare Billing Journal or webinars of learning. Did I help you?
Take Care
Lady T

 

[laylaykali]

Hi Laylaykali,
It seems you are doing this correctly with CPT 90791 and inpt psych codes 99231 -99233, but no idea of HCPCS to use in that setting. Understand MD, PA, DO psychiatrist and psychologist can bill for it. Psychologists should have separate education in medications some do not. Psych docs can bill for just about anything but especial medication management whereas LCSW and LPC cannot bill for that process CPT 90792. Understand differ in remission vs history of in Beh Health Dx codes. Hopefully docs and therapists are mentioning date in regards to the psych pts past mental health hospitalizations or problems. Also most payers will accept CPT 90791 for one time for each different dx type pt treated for in the year. So if pt. comes in for dx F32 one time can use CPT 90791 but if pt. returns to use again the CPT 90791 must be a differ mental health problem. In other words CPT 90791 can be used one time on one dx problem for the year. The payers only pay for this CPT 90791 one time a year UNLESS each different illness/problem.. Here are some other tips ...Use dx F90 for children not adults , use F53 and O99.35 if pregnant mom depressed and postpartum , watch out for Excludes 1 Rules but your Encoder system should warn you a bit about that situation. If clinician documented can add dx R44-R46 if applicable. Use those Z codes lastly on claim if apply to the documentation...Z63, Z86.5 Z39, Z13.31, Z02.83(first listed Z code dx) and Z04.39 and Z13.31.
Good luck! Also Goggle the billing issue this helps your understanding too. They have websites of psych billing and read the Healthcare Billing Journal or webinars of learning. Did I help you?
Take Care
Lady T

Thank you so much for this information it's been very helpful!!

 

[spalac4@wgu.edu]

Hi Laylaykali,
It seems you are doing this correctly with CPT 90791 and inpt psych codes 99231 -99233, but no idea of HCPCS to use in that setting. Understand MD, PA, DO psychiatrist and psychologist can bill for it. Psychologists should have separate education in medications some do not. Psych docs can bill for just about anything but especial medication management whereas LCSW and LPC cannot bill for that process CPT 90792. Understand differ in remission vs history of in Beh Health Dx codes. Hopefully docs and therapists are mentioning date in regards to the psych pts past mental health hospitalizations or problems. Also most payers will accept CPT 90791 for one time for each different dx type pt treated for in the year. So if pt. comes in for dx F32 one time can use CPT 90791 but if pt. returns to use again the CPT 90791 must be a differ mental health problem. In other words CPT 90791 can be used one time on one dx problem for the year. The payers only pay for this CPT 90791 one time a year UNLESS each different illness/problem.. Here are some other tips ...Use dx F90 for children not adults , use F53 and O99.35 if pregnant mom depressed and postpartum , watch out for Excludes 1 Rules but your Encoder system should warn you a bit about that situation. If clinician documented can add dx R44-R46 if applicable. Use those Z codes lastly on claim if apply to the documentation...Z63, Z86.5 Z39, Z13.31, Z02.83(first listed Z code dx) and Z04.39 and Z13.31.
Good luck! Also Goggle the billing issue this helps your understanding too. They have websites of psych billing and read the Healthcare Billing Journal or webinars of learning. Did I help you?
Take Care
Lady T

Hello,

Could you help me with a question. I understand that 90791 cannot be billed in conjunction with an e/m by the same individual. Does that mean all the providers in the same office? or just an individual? We have an LCDC billing 90791 and the MD is billing an E/M on the same date of service. Is this allow?

 

[TThivierge]

Hi
Yes it is allowed. From my understanding CPT 90791 is billed one time per beh.health problem. Some payers say once per year. CPT 90791 cannot be billed with another psych CPT code or eval mgmt is true by same person. The MD billing Eval mgnt for medical problem is fine on same day. Differ providers can do Eval mgmt and CPT 90791

Lady T