Denials due to the new Mental Health Codes

Just a reminder that the mental health CPT codes changed effective for dates of service 1/1/2013.  Make sure you are using the correct codes.  If you use the old codes that were changed then you will receive denials.  Many of the commonly used mental health codes have been deleted and replaced with new codes.

Anyone who bills for a psychologist or a social worker is familiar with the 90806 or the code for individual psychotherapy for 45 to 50 minutes.  Well as of January 1st that code is no longer valid.  They have replaced the 90806 with a new code, 90834 which is individual psychotherapy for 45 minutes.  They’ve also deleted the 90801 and replaced it with two codes 90791 which is Diagnostic Interview without medical and 90792 which is Diagnostic Interview with medical.


For most psychologists and social workers the changes are basically just swapping out one code for another, but for psychiatrists they are much more involved.  Most psychiatrists used to bill for Medication Management using CPT code 90862.  The 90862 code has been deleted but no equivalent was assigned.  Instead psychiatrists must bill for an E&M code (99201-99215) and then an add on code for any psychotherapy.  So for example, if a psychiatrist sees an established patient for a review of their medication, they would bill the appropriate E&M code (99211-99215).  If they also do any psychotherapy in addition to the E&M code then they would pick the appropriate psychotherapy code depending on how much time was spent with the patient on the psychotherapy and bill that in addition to the E&M code.  They cannot bill for the time spent on the E&M as part of the psychotherapy.


The codes for mental health services have not changed in many years.  Some of the codes remained the same, not all were changed.  The group therapy and family session codes were not changed.  In any case it is important that all mental health providers are aware of these changes.


Billing with any of the deleted codes will cause denials.  For example, if you bill using a 90806 for a date of service after 1/1/13 you will receive a denial most likely similar to “invalid procedure code used”.  If you start seeing these denials, take a look at the code you used to determine if it is one of the deleted codes.  If it is, change it to the correct code for 2013 and resubmit the claim.


If you still are confused over the changes or just have questions, visit the forum:

Changes in NYS Workers Comp for Chiropractors

I know this doesn’t affect everyone but it’s still interesting, at least to me.  In 2010 most states revamped their workers comp systems and the changes affected many providers, not just DC’s.  They tried to pass of the changes in a positive light stating that doctrs would be reimbursed higher rates.  While that was true to a point, the new rules actually limited providers greatly on the treatment they could provide to workers comp patients.  I understand the point behind the action.  There are many patients out there (and we’ve all seen them!) that continue to receive treatment under a workers comp case for years and years.  I’m not saying that some patients don’t need treatment for years after a severe injury but you guys know what I’m talking about.

These changes also affected patients greatly.  I personally know of a woman who tripped at the school she worked at on a rug that was torn and should have been repaired months earlier.  She fractured her wrist and it was a bad fracture.  It required surgery and physical therapy.  I didn’t mention that she was the music teacher and a great pianist so it was really a bad injury for her.  Anyway back to the point, she was denied necessary therapy due to the new rules.  So these new changes didn’t just affect the doctors, but also the patients.

Not much has been said or done (at least to my knowledge) since the changes were enacted.  But recently a DC sent me an article from an email he received and it states that starting in February 2013 NYS comp is going to start to allow chronic care and maintenance care for patients with neck, back, shoulder and knee injuries.  This doesn’t just affect DC’s.  It also affects PT’s, OT’s, DO’s and MD’s too.  And, to me it’s a sign that they are recognizing that some of the changes made in 2010 aren’t working.  So we will have to see where this goes.  I’m hoping it’s the sign that they are now taking a look at fixing the issues that have arisen from the previous changes.