The Centers for Medicare & Medicaid Services (CMS) has recently launched the ICD-10 Clinical Concepts Series for healthcare providers to use ICD-10 diagnosing codes. In this guide, each series features key information about the updated ICD-10 medical codes. This series consists of 6 significant specialties and includes standard medical codes, clinical documentation tips, and clinical scenarios.
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For most medical care, you bill a current procedural terminology (CPT) code based on the service. For example, you would use CPT code 36415 for a blood draw or code 99385 for a well-woman visit for a new patient ages 18-39.
But mental health visits can vary in the amount of time they take, which means the mental health billing codes vary, too. After a visit, you’ll bill the code that’s closest with the amount of time you spent with the patient. For example:
90832: 30 minutes of individual psychotherapy (fits for sessions 16-37 minutes)
90834: 45 minutes of individual psychotherapy (fits for sessions 38-52 minutes)
90837: 60 minutes of individual psychotherapy (fits for sessions 53+ minutes)
90846: 50 minutes of family psychotherapy without the patient/client (fits for sessions 26+ minutes)
90847: 50 minutes of family psychotherapy with the patient/client (fits for sessions 26+ minutes)
Since the COVID-19 pandemic, more clinicians are providing mental health care via telehealth. In some cases, you may be able to bill the same CPT codes for telehealth as you would for in-person visits. But, you must add a modifier to the code.
95 modifier: Add this to a code if the interaction is real-time (not recorded) but done virtually via telecommunications system (such as a video chat).
02 modifier: This code shows that the point-of-service (POS) for the interaction was a telecommunications system. By contrast, you would use the 11 POS code for an in-office visit.
There is also a separate set of behavioural health telemedicine billing codes under the Healthcare Common Procedural Coding System (HCPCS). These codes sometimes start with the letter “G” rather than a number. For example:
G2010: Remote evaluation of an established patient’s recorded video
G2012: Virtual check-in or short, patient-initiated visit
Other HCPCS telehealth codes can include:
99421: Online evaluation and management with an established patient; five to 10 cumulative minutes over seven days
99422: Online evaluation and management with an established patient; 11-20 cumulative minutes over seven days
99423: Online evaluation and management with an established patient; 21+ cumulative minutes over seven days
ICD-10 codes follow a common convention, making it easier to determine which code is the most accurate one for a particular case. Knowing how the codes are composed will help you navigate them more easily.
All ICD-10 codes start with a single letter, followed by three or more numbers. The G codes all refer to diseases of the nervous system. The Z codes cover situations where the client doesn’t have a specific disorder, such as Z91.4 (personal history of psychological trauma) and Z04.6 (encounter for general psychiatric examination, requested by authority).
The majority of the mental health ICD-10 codes are F codes, which are divided into the following categories.
F00–F09 — organic, including symptomatic, mental disorders
F10–F19 — mental and behavioral disorders due to psychoactive substance abuse
F20–F29 — schizophrenia, schizotypal, and delusional disorders
F30–F39 — mood disorders, depression, and bipolar disorders
F40–F49 — neurotic, anxiety, stress-related, and somatoform disorders
F50–F59 — behavioral syndromes associated with physiological disturbances and physical factors
F60–F69 — disorders of adult personality and behaviors
F70–F79 — intellectual disabilities
F80–F89 — pervasive and specific developmental disorders
F90–F98 — behavioral and emotional disorders with onset usually occurring in childhood and adolescence
F99 — unspecified mental disorder
Having a thorough understanding of the most common mental health CPT codes will help ensure that you’re using the best code for the services you provide. Here are the most common codes that you’ll encounter as a therapist.
90837 – Psychotherapy, 60 minutes
90834 – Psychotherapy, 45 minutes
90791 – Psychiatric diagnostic evaluation without medical services
90847 – Family psychotherapy (with client present), 50 minutes
90853 – Group psychotherapy (other than of a multiple-family group)
90846 – Family psychotherapy (without the client present), 50 minutes
90875 – Under other psychiatric services or procedures
90832 – Psychotherapy, 30 minutes
90838 – Psychotherapy, 60 minutes, with E/M service
99404 – Preventive medicine counselling and/or risk factor reduction intervention(s) provided to an individual (separate procedure)
Code modifiers are used to convey additional information to a payer, such as the level of provider or when services were provided. There are many different modifiers, but only a few that are commonly used. You’ll want to become familiar with the following modifiers.
Modifier 25 — Typically, a single code will accurately describe a session. But occasionally, you may find that a fully separate E/M service is needed (performed by the same provider) on the same day. In this case, modifier 25 calls out that service as separate and reimbursable. Note that you can only attach modifier 25 to codes 99201-99215, 99341-99350.
Modifier 59 — This modifier is similar to modifier 25, but it’s used to describe a distinct non-E/M procedural service done on the same day. Note that your documentation must support a separate session.
Modifier GT — Used for telehealth sessions involving interactive audio and video.
Modifier UT — Used when the provider sees a patient in crisis.
There’s no denying the fact that behavioural health billing is complex. What’s more, mental health practices are often small — in most cases, there may not be a billing team to help with claim submission and coding.
But that doesn’t mean that your practice should go underpaid or worse — unpaid. Following these tips can help make sure you’re optimising billing for mental health services and maximising reimbursements.
Verifying benefits is the most important part of the revenue cycle management (RCM) process. If you don’t understand the patient’s coverage before their appointment, you could lose the claim from the get-go.
Having a reliable and instant eligibility tool is a great start. It’s also helpful if your eligibility tool can automate some of the processes for you (this is especially helpful for those small practices). Ideally, the tool can automatically check patient benefits for the week’s schedule and notify you if there are any issues or expired plans.
Detailed patient documentation will help you with both prior authorizations and claim appeals. Aside from accurate demographic information, make sure you have specifics on diagnosis, medications and treatments. It’s also helpful to document all steps in the prior authorization process if it’s needed.
Every payer is different, which means each one will have different forms and criteria you need to file claims. Even if you’re only working with one or two payers, it’s important to understand the nuances of each to avoid claim rejections or denials.
Don’t wait to file your claims. Since the process is often drawn out and complicated, starting as soon as possible will help make sure you’re getting paid in a timely manner.
If you find your practice is struggling to manage a healthy reimbursement process, it might be time to partner with an RCM expert. You could add a smart software solution to augment your existing team. The software can provide automated claim workflows that save time and reduce errors.
Or, you may want to consider a fully-managed RCM solution. This option comes with a team of revenue cycle experts who know how to maximise your reimbursements.
