Billing for Mental health services within a primary care setting can be a challenge, due in part to the variability in requirements across private and public insurers.
Mental health services, for which billing may prove a challenge, include:
- Coordination and case management.
- Consultation with other providers.
- Screening and treatment of mental health problems.
- Outreach and Education.
How do you bill for Diagnostic and Treatment Services?
Diagnosis is billed using the International Classification of Diseases (ICD) coding system. Treatment is billed using either the Current Procedural Terminology (CPT) or the Healthcare Common Procedure Coding System (HCPCS).
Mental Health Diagnosis (ICD 9 and ICD 10):
Diagnoses are reported to both public and private insurance carriers using the International Classification of Diseases, Clinical Modification (ICD-9-CM) which provides a classification system for diseases and injuries. The Department of Health and Human Services will replace the ICD-9-CM codes with greatly expanded ICD-10-CM (diagnosis) and ICD-10-PCS (hospital procedure).
Mental Health Treatment (CPT and HCPCS Codes):
Mental health treatment services are reported to both public and private insurers.
CPT Codes:
CPT codes were developed and are maintained by the American Medical Association. They are numbers assigned to every service a medical practitioner may provide to a patient including medical, surgical and diagnostic services and are used by insurers to determine the amount of reimbursement that a practitioner will receive.
HCPCS Codes:
Medicare and Medicaid use HCPCS codes. HCPCS codes are monitored by the Centers for Medicare and Medicaid Services (CMS).
Levels of HCPCS codes:
There are three levels of HCPCS codes, two of which are relevant to mental health billing.
HCPCS Level I codes are numeric and are based on CPT codes.
HCPCS Level II codes are alphanumeric and primarily include non-physician services such as ambulance services.
Medical Record Documentation:
Medical record documentation improves success in billing. The general principles of medical record documentation for reporting of mental health services include:
- Medical records should be complete and legible.
- Documentation of each patient encounter should include.
- Physical examination findings and prior diagnostic test results.
- If not documented, the rationale for ordering diagnostic and other ancillary services should be easily inferred.
- Patient’s progress, response to changes in treatment, and revision of diagnosis should be documented.
To ensure the financial health of your mental health billing services, fast, efficient. Don’t Wait Contact us +1(302) 613-1356 today to learn more.