Practice Management Alert

Understanding mental-health coverage policies is essential if your physician treats and counsels patients with depression. Follow these four steps for success: 1. Code by time. Make sure there is documentation that more than 50 percent of the visit's face-to-face time consisted of counseling. You should report the appropriate level E/M code based on the total face-to-face time the physician spent with the patient performing history, exam, medical decision-making, counseling and coordination of care. 2. Link the E/M to the proper ICD-9 code. If the physician documents depression, you must report the appropriate code, such as 311 (Depressive disorder, not elsewhere classified). When there is no definitive diagnosis, rely on signs-and-symptoms coding and report problems such as fatigue (780.7x) and lack of sleep (307.41) as justification for the E/M. 3. Remember mental-health coverage limits. When you bill for depression treatment, the claim will likely fall under Medicare or a private payer's mental-health coverage - and some carriers have frequency limits. 4. Develop payment protection. Under Medicare, patients are responsible for paying 50 percent of all mental-health services - so make sure patients are aware of their payment obligations. For other payers, you may want to develop a form stating that the patient is responsible for the bill if the carrier refuses coverage.