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  Well as of January 1st that code is no longer valid.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:  www.medicalbillinglive.com/members

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6 Responses to “Denials due to the new Mental Health Codes”

  1. Shannon Kropp Says:

    I’m curious to see how many other rejects are going to come out of this situation. For instance, with all of the mental health carve out plans (Magellan, Value Options, ComPsych, etc), how many are now going to reject Psychiatrist claims that used to go to them for “services not covered by this payer”. I bet this will be yet another issue providers will be dealing with. I have not seen any rejections yet, but I am preparing myself to see them.

  2. Kim Derum Says:

    I agree. Also I wondered if you could answer something for me? I’m trying to help one of my providers who is a psychiatrist M.D. understand how to code her billing sent to me. I understand and conveyed how to bill E&M codes with psychotherapy however I want to make sure …the provider does NOT need to supply an E&M code when submitting a 90762 correct?

  3. Shannon Kropp Says:

    Kim, I’m sorry that I did not respond sooner…I just saw this. 😦 Anyway, the psychiatrists I am billing for are shying away from the 90762 code and are using the 99211-99215 codes along with a psych add on code. Might be something to look into for your psychiatrists.

  4. Kim Derum Says:

    Thanks Shannon, will do.


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