Wiki SUD billing

[jamie.mcalpin57@gmail.com]

Asking for clarification around billing SUD claims. We are a substance use disorder facility offering several programs including WM, short term residential, MAT, continuing care and outpatient. All billing is submitted under one facility NPI number as all staff are employees. We have medical physician, CNP, nurses and counselors with varying degrees. Staff schedules MAT and outpatient clients same day . Therefore, we have 2 counselors, in different programs offering individual therapy on the same day, specifically in MAT for medication management and in Outpatient for ongoing issues relating to health, environment, choices, etc . How would we bill both a 90832 and a 90834 on separate claims to specify separate programs, different clinicians providing individualized care on the same day without one being denied? TIA

 

[TThivierge]

Hi Jamie
I d bill the CPT 90832 and 90834 for each differ therapist (hopefully for a differ dx problem) modifier 27. This modifier can be used for same date and same patient in differ outpatient settings. Are you doing telehealth services too? CPT 99441-99443 for psychiatrist but must verify correct patient, ensure put this on top of note if using phone or video for this date of treatment and permission from pt.. Also patient can be telehealth with peer specialist, CNP and Nurses using CPT code 98966 series. Ensure put in amount of ,minutes treated any telehealth patient. Also please list the dx code in documentation and describe problem. You may get denied if the patient s insurance have maxed benefits for beh. health diseases. Also the docs and LCSW need to mention the ongoing medical health problems/chronic illness suffering with by using eval mng office code 99214 with modifier 95. Half the treatment note can address mental health problem and then other half note address chronic medical issues. .Then put on claim 90832 and 99214 both modifier 95 if telehealth .
The dx codes of F43.23 and, R45 dx blocks and Z56 dx block social determinants can be used if in the medical documentation is applicable. One more thing ensure the define subs abuse per list types '''alcohol, cocaine, cannabis, pills,Etc.
I hope this data helps you
Lady T

 

[jamie.mcalpin57@gmail.com]

Hi Lady T,
Thank you so much for your detailed response explaining the best way to bill these codes. I am anxious to share this info with my billing peeps and am sure they will be grateful as well. We do use telehealth but thankfully have had no issues with reimbursement. Again, TYVM!
Best,
Jamie