# Psychiatry and Mental Health



## MJ4ever (Sep 22, 2008)

Hello,

Is there anyone out there with coding experience in Psychiatry and Mental Health?
I am specifically searching for documentation requirements.

Thanks so much,
Barbara Andrade, CPC


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## Susan (Sep 22, 2008)

Barbara;

In what respect are you coding Mental Health?  If you look at the 97 Guidelines for Psych as that will give you a good guide for what should be documented for each level of service.  

Have a great day!


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## heatherwinters (Sep 23, 2008)

*Documentation*

I have been struggling through this as well, see page 39 and 40 of the following
http://www.cms.hhs.gov/MLNProducts/downloads/MASTER1.PDF


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## grahamki (Sep 23, 2008)

I work in the mental health field.  We use the 95 documentation guidelines for E&M coding for inpatient stays.  It is actually much easier for our physicians to go by these guidelines then by the 97 guidelines. 

Hopes this helps!


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## MJ4ever (Oct 4, 2008)

Thanks so much for everyone's help.
What I was specifically looking for was the documentation for Licensed Clinical Social Workers, such as for initial assessments or psychotherapy.
When you're brand new to having to code for mental health and get bombarded with questions, it can get tough. I will look over the 1995 guidelines again, which we are supposed to use.
What was confusing to me, is, that social workers are only to use procedure codes, not E&M codes, and I had the impression that the documentation guidelines for procedures would be different from the E&M documentation guidelines.
Thanks again for all your answers.


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## kevbshields (Oct 5, 2008)

Well the documentation of psychotherapy or an E/M aimed at a possible mental disorder is usually substantially different than that in the other areas of medicine.

Medicare has some very good information on the provider types and crosswalks to the codes recognized for each of the clinical types.  Although LCSW may not use E/M, that does not change the documentation requirements substantially; the time must be documented, modes of therapy should probably be documented, the patient must have a diagnosis recorded--or a reason for the visit.  The record should also demonstrate an appropriate level of detail respective to the services provided.

Hopefully these won't be too vague and will get you on the right track.  I actually prefer coding for the "psych" visits more than medical E/M . . . just seems to be less cumbersome.

Good luck to you.


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## MJ4ever (Oct 5, 2008)

Thanks so much for your guidance in the right direction.


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## KristiMass (Jan 2, 2009)

Does anyone know what the different is between a Phd. and an MD when it comes to reimbursement?  Medicare does not specify a difference but the managed care payors reimburse the Phd. at a lower reimbursement 75% of the Medicare allowable.  I know this is not a particular coding question, but hoped someone may know the answer?

Thanks,
Kristi Kendrick, CPC


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## 1073358 (Jan 6, 2009)

Check out Medicares guidelines on this:
http://www.wpsmedicare.com/part_b/policy/policy_active.shtml

Scroll down to psych 014


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## hgarrett113 (May 13, 2009)

*Need Help!!*

Barbara,
Did you find out how to code for a Licensed Clinical Social Worker? I am trying to learn now. I have tried looking for seminars to attend to find out more information but can't find any. The practice where I work wants to have our new LCSW's separate practice "up and running" by August. So I am kind of in a hurry to find information and learn how to code for her. Any advice?

Hollie Garrett, CPC


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## sdeaton (May 15, 2009)

KristiMass said:


> Does anyone know what the different is between a Phd. and an MD when it comes to reimbursement?  Medicare does not specify a difference but the managed care payors reimburse the Phd. at a lower reimbursement 75% of the Medicare allowable.  I know this is not a particular coding question, but hoped someone may know the answer?
> 
> Thanks,
> Kristi Kendrick, CPC



Kristi,

I've worked for payers for appx 20 years and based on that experience, commercial payers fee schedules do vary for the PhD versus MD.  Generally, PhD rate is about 25% lower than MD, regardless whether fee schedule is based on the Medicare fee schedule or some other calculation.  Additionally, MSW and other counselors are lower than PhD rate.

I'm not sure what the difference is today because many payers, including my current employer, use a 3rd party vendor for behavioral health and I'm not privy to those fee schedules.

Is there a particular basis or reasoning for the difference?  I can only guess that either now or at a time in the past, Medicare paid them differently.  It is similar thinking that created the disparity between CRNAs (nurse anesthesists) and MD anesthesiologists.

Hope that helps a little!


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## jrsivyer (May 21, 2009)

I've found the CPT Handbook For Psychiatrists, Third Edition, by Chester W. Schmidt, Jr., M.D, Rebecca K. Yowell, and Ellen Jaffe to be very helpful. The ISBN number is 1-58562-157-9. It's published by American Psychiatric Publishing, Inc. www.appi.org


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