behavioral health

  1. M

    Wiki 96127 and telehealth

    Hello, We are a telehealth only company. Our nurse practioners have always billed 96127 when interpreting the Vanderbilt assessment. Iowa Medicaid has recently told us this code was taken off the list of allowable telehealth codes as of 12/31/23, however CMS still allows this to be billed with...
  2. E

    Question 90887 and 90847 Bundled???

    Hi, I'm new to BH billing and I'm getting denials for 90887 and 90847 under Cigna specifically -- their coding tool says that it should be bundled as per CMS guidelines, but when we bill the same codes under Medicaid, we get paid. Does anyone have any insight on this? I would really like to get...
  3. H

    Wiki Medicare CMHC Credentialing

    Hello, I work with Mental health practice and facilities. One of my Medicaid only Residential SUD Facilities is now enrolled with Medicare Part B and would like to bill for IOP and PHP services. I cannot find in the Medicare manual that this is covered unless they are a CMHC. I have submitted...
  4. J

    Wiki MDM Grid

    Hi all! I'm relatively new to behavioral health coding and am looking for E&M resources for both outpatient office visits and inpatient psych (for profee). I've been told by co-workers, who work in other specialties, that they've found adapted MDM grids more geared to their specialty. Does...
    • JennyMarie19
    • Thread
    • behavioral health e&m evaluation and management inpatient coding mdm mdm elements mdm leveling profee professional coding psychiatric coding
    • Replies: 3
    • Forum: Behavioral Health
  5. B

    Wiki Outpatient provider providing services to patient in the hospital

    Hi all, I have not come across this before so was hoping to get some guidance. I work for a behavioral health group practice in an outpatient setting (mainly office and telehealth). One of our LCSW's patients was admitted to the hospital due to an unrelated condition, and requested a session...
  6. N

    Wiki Outpatient psychotherapy documentation - start/stop times?

    Hello. When billing with E&M, do our psychtherapy notes need to contain specific start and stop times for the psychotherapy portion of the visit, or is an overall time statement permitted, example "18 minutes was spent". Any insight is greatly appreciated. Thank you so much!
    • Nexus
    • Thread
    • behavioral health behavioral health billing psychotherapy
    • Replies: 1
    • Forum: Behavioral Health
  7. E

    Wiki Billing 96127 and Medicare

    Are any behavioral health offices billing 96127 with Medicare? If so, what are the requirements? Documentation and screening? Thanks!
    • ElleK
    • Thread
    • 96127 behavioral health behavioral health billing medical biller medicare medicare and 96127
    • Replies: 0
    • Forum: Behavioral Health
  8. C

    Wiki New Patient to group but Est. To provider under different tax ID?

    looking for some clarification on this.. as information given by one of our Behavioral health insurances is conflicting. we recently hired a new provider to our group who practiced with another group in the area Same specialty but Different Group NPI and Tax ID This provider will be bringing a...
  9. B

    Wiki Psychotherapy via Telehealth While on Vacation

    Hi there, and thank you all in advance! I have a behavioral health provider (LPC) who has an opportunity to work remotely in another country for a few months and was hoping to continue to see their patients via telehealth while away. The provider is licensed in the state all of their patients...
  10. W

    Wiki Office visit E/M (MAT) and behavioral health coding

    I just started with a client that does Medication Assisted Treatment (MA.T) The way they have been billing, is that the provider who does the medication management portion (and any other conditions) will bill the office visit E/M code with a modifier 25, and the counselor bills a...
  11. A

    Wiki G0317 Prolonged Service, how to bill

    Do you have to bill the prolonged service G0317 on the same claim form as your E/M visit, (99306-99310) or can this code be billed separately on it's own?
    • amjamil
    • Thread
    • behavioral health claim claim form e/m nursing facility prolonged psychiatric
    • Replies: 2
    • Forum: Billing/Reimbursement
  12. M

    Wiki CBT 97129, 97130 vs 90832,34,&37

    Hello, I am trying to determine what the most appropriate code selection would be for cognitive behavioral therapy. I have a few clinicians and coders who are saying 97129 and 97130 would be more appropriate then codes 90832,90834,90837. I personally think CBT is a form of psychcotherapy...
  13. S

    Wiki Using an SUD specific CPT code with a BH diagnosis

    Hi there, I am trying to do some research about using 99408 which is - Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services and having a BH diagnosis for example F42.9 Obsessive-compulsive disorder, unspecified. Does...
  14. L

    Wiki patient cost estimator/availity/aetna

    Has anyone found an alternative to get patient cost estimates from Aetna that doesnt requiring calling them directly? I work for a behavioral health practice and we have obtain estimates on neurological testing. Availity's patient cost estimator tool has not worked for a long time. Availity...
  15. E

    Wiki ABA BILLING

    I need some help. I have a client with commercial insurance as primary and Medicaid secondary. Both insurances paid but there is still a 19.00 balance left. I should know what to do but I don't, what do I put it under?
  16. M

    Wiki Place of Service questions

    Hello! I am a somewhat new biller and got my experience solely from the office I currently work at and through AAPC billing course. I work for an Outpatient Drug and Alcohol treatment center, we also provide co-curring mental health/substance use services. The POS, Place of Service is always a...
  17. C

    Wiki CPC 5 yr experience

    CPC certified, looking for a remote coding opportunity overseas, 5 years experience with ICD 10 and CPT coding. Looking for a position where my coding, technology, and organizational skills can be used to help a company to reach their goals. Willing to relocate: Anywhere Authorized to work in...
    • clcutting
    • Thread
    • behavioral health cpc cpt emergency coding experienced icd 10
    • Replies: 0
    • Forum: Resume Postings
  18. J

    Wiki UDS help

    We are switching to a new software soon and we normally have our MA's put the UDS and results in a note and sign it then the provider also signs it. Do we have to do this? Or can we just have them put it in as a non billable then when the provider interprets it, he change it to the 80307 and...
  19. M

    Wiki Injection given in patient's home

    The office I work for (outpatient behavioral health) is planning to start having nurses go to patient's homes to administer psychiatric medication injections. Is this billable as "incident to" since the provider is not in the building where the patient is having the injection done? If not, is...
  20. Y

    Wiki LPC Billing for Professional Consultation

    Hi everyone, Can an LPC bill for a consultation with a teacher or school counselor? I am leaning towards not billable but thought to ask in the forums, JIC. First time!
  21. A

    Wiki Billing IOP for Medicare Patients

    Does anyone have any tips for getting Medicare to Reimburse for Intensive Outpatient Programs (IOP)? I've been reading and looking over guidelines and I can't find anything useful. To make matters complicated, I believe my organization is technically in the process of getting credentialed now as...
    • Arnkpc
    • Thread
    • behavioral health colorado medicare intensive outpatient program
    • Replies: 6
    • Forum: Behavioral Health
  22. buskeys

    Wiki Behavioral Health and Psych Resources

    Hi! Does anyone have any good Behavioral Health and/or Psychiatry resources for coders? Whether that be books, manuals, articles, papers etc. Thanks :)
  23. A

    Wiki Extended Group therapy Code?

    Hello, I just started a new job at a Behavioral Health Organization. I have been trying to help them improve upon their coding. One thing I haven't been able to find, is a good code to use for 2 hour group therapy session. It is not family members, groups are around 10 people, and they are...
    • Arnkpc
    • Thread
    • 90853 add on codes behavioral health group therapy
    • Replies: 3
    • Forum: Behavioral Health
  24. R

    Wiki Adolescent Residential billing for MH and SUD

    I need help. I have been billing for adults my whole career, but now have some questions regrading adolescents. This would be for residential care at a residential facility. Primary dx will usually be MH, and I cannot find any specific information on if billing will even change from what I am...
    • randalstarr
    • Thread
    • adolsecent behavioral health mental health residential substance abuse
    • Replies: 1
    • Forum: Behavioral Health
  25. C

    Wiki Billing for Case Management (98966-98968)

    Hello. I am new to billing for Behavioral Health and I want to make sure I'm doing so correctly. Any help to lead me in the right direction is appreciated so, thank you in advance! I have a therapist that sent me a message for me to bill "Case Management via Telephone" for a patient. When...
  26. A

    Wiki bill psychotherapy codes before assessment?

    The behavioral health providers at our clinic asked me how many times they can bill 90832 psychotherapy before an assessment 90791 is required. They think that they can bill up to 4 sessions before they complete an assessment. I cannot find any coding/billing information to support this idea...
  27. E

    Wiki 90971/90972 vs 9920x

    I am new to behavioral health, and I want to know when the appropriate times are to use these codes. I work on a college campus, so our providers are sometimes the first psychologists and psychiatrists to treat a client (and do the diagnosing). In that instance, the providers (psychiatrists) are...
    • erbrinkmann
    • Thread
    • 90971 90972 99201-99215 behavioral health mental health psychiatric coding psychology
    • Replies: 1
    • Forum: E/M
  28. M

    Wiki Behavioral Health Job Openings - Compliance Specialist and Payment Integrity Manager

    Large Behavioral Health Payer looking for experienced candidates (at least 2-3 years) with excellent analytical skills and experience dealing with large data files, behavioral health coding/billing compliance experience for all lines of business (Medicare, Medicaid, Commercial). Advanced Excel...
    • mdimitrov
    • Thread
    • behavioral health behavioral health jobs job offers job opportunity job posting
    • Replies: 0
    • Forum: Behavioral Health
  29. R

    Wiki Substance TX and Private Insurance Billing

    I bill for a group practice that is fairly new to private insurance. Our main payer is state medicaid. I am having a hard time trying to get info on how to bill private insurances when services are rendered under a certified addiction counselor...the state of Maryland acknowledges CAC's but most...
  30. M

    Wiki Coding Help for ABA-Autism Billing

    Can anyone help me with a billing/coding question in regards to ABA services, codes 0364T and 0365T? I need to know what the guideline/rules are for billing the secondary code 0365T, as far as the times/rounding up? What is the guideline, for billing the secondary code and rounding up? Does it...
  31. J

    Wiki Primary Payor Determination - HELP! BH Offices and Beyond

    I need some help please. I am working with some Behavioral Health Offices that are having some issues determining Primary Payors. I am looking for a chart or decision tree or anything that will not only look at Medicare vs Group Health but all payors. Because more often than not we are billing...
  32. S

    Wiki Behavioral Health billing to Medicare Part B

    When billing for BH services- intake and ongoing- where do you find the code sets used for Medicare part B in Arizona? I submitted an H0031 and it was denied. Does anyone have any information to share with me, please, any help or guidance would be greatly appreciated. This is a new area in our...
  33. J

    Wiki BH Assessments - ER Diagnosis Codes

    I code for BH and I receive BH assessments (completed by LSCSW) in the ER. I am having issues with the diagnosis coding. On one hand there are the diagnoses, signs, and symptoms the patient (or outside source) reports. On another hand the LSCSW reports different (or the same) diagnoses in the...
  34. J

    Wiki Behavioral health coding- help!

    Hello coding world, I am a brand new coder and took a position as the only coder/biller at a small counselors office. So, I don't have anyone above me to help with my questions. The question is regarding Arizona Medicaid and the correct code for services. The HCPCS code for a drug and/or...
  35. J

    Wiki Group- Substance/Alcohol Abuse

    I am in Arizona and bill for a counselors office. I am wondering which code to use for a group therapy that is for substance and/or alcohol abuse. It is an intensive outpatient therapy but not all of the patients attending the group sessions meet the HCPCS requirement for the group (H0015; which...
  36. R

    Wiki New to Behavioral Health

    Does anyone have any good resources (books,websites,guidelines,etc) that they find useful when coding for Behavioral Health? Our clinic just recently brought on two Behavioral Health providers and I would appreciate any and all recommendations on coding for Behavioral Health as this will be a...
  37. S

    Wiki Lcsw credentialing

    I'm VERY new to behavioral health coding/credentialing. Does ANYONE have any helpful tips/resources I could utilize in making this transition easier? Also, they want me to credential a LCSW (licensed clinical social worker) is it the same as a Dr/PhD or different?
  38. B

    Wiki Therapeutic Youth Group Home Coding/Billing

    I work for a Mental Health Center, and we also have several Therapeutic Youth Group Homes. We bill S5145 to Medicaid for the group home services, which is what our state requires. However, they have also been trying to bill this code to all the private insurance companies for families that have...
  39. G

    Wiki DSMV crossover to ICD10 Help!

    Hello all, I am having trouble choosing the appropriate ICD10 code for the following DSMV: Major Neurocognitive Disorder due to Traumatic Brain Injury, with behavioral disturbance. Any suggestions? The closest I can find is F02.81, but that lists dementia and the provider does not like this...
  40. A

    Wiki Billing H0023 for Medicaid

    I am wanting to know if you could use H0023 more than once for a member specifically if you were trying to engage them. For example: you had an open group (non-billable) to provide education, support, etc. but it is not designated for established clients in an agency. What if a person comes more...
  41. T

    Wiki Billing 96152

    We are an FQHC in Arizona. We have an LCSW. We need to bill 9615x codes but keep getting denied saying a modifier is missing. Example: T1015 FQHC Visit 96152 Health and Behavioral intervention, each 15 minutes, face-to-face, individual Anyone know what modifier we would use? Thanks, Theresa...
  42. S

    Wiki Advice on best book to have on hand for Behavioral Health coding & Billing

    Just started Billing & Coding for a Behavioral Health Center and wanted to see if anyone had suggestions on the best book & or tools to have on hand. I looked through AAPC, but wanted any and all opinions. Thank you for any and all help!!!
    • Sue2424
    • Thread
    • advice/pros/cons behavioral health books/tools mental health substance abuse
    • Replies: 1
    • Forum: Behavioral Health
  43. C

    Wiki Grant funding vs Using insurance

    Hello, I work for a nonprofit mental health center that accepts insurance but is largely funded by grants. I am having a hard time getting straight answers from our contracted payors (insurance companies) so I am looking for some guidance to balance grant funding for services where the client...
  44. J

    Wiki BH cheat sheets / Decision Trees

    I am taking on a new practice in need of some assistance for old 2016 claims and forward. Does anyone out there by chance have any cheat sheets, audit tools or training materials that they can share? It has been a few years since I have done Behavioral Health and would appreciate any assistance.
  45. C

    Wiki Poisoning Codes - need clairification please

    Maryland Value Options Medicaid (Behavioral Health) will cover poisoning codes in categories T36-T50; however, not all codes. Is it correct to assume that those codes in T36-T50 ending with 5 or 6 (adverse effect and underdosing) are not poisoning codes? We need to flag the poisoning T36-T50...
  46. 0

    Wiki Searching for CPT: Cogmed Working Memory Training

    I have been searching for the most appropriate code for Cogmed Working Memory Training. It consists of using a computer (in part) for cognitive therapy. This therapy is sometimes used after TBI; however, it has been used to treat other conditions such as ADHD. The program is 25 sessions that...
  47. A

    Wiki Behavioral Health in-home

    Does anyone have any experience or knowledge as to whether psychotherapy (codes 90791-90834-90837-90846 provided by LCPC/LCSW) can be reimbursed if the visit took place in home? It appears that Medicare will reimburse for POS 12 for LCSW but I can't find any clarity on other license levels or...
  48. K

    Wiki Residential Treatment and DCS Contracts

    I work for a mental health facility that has a contract with DCS as a residential treatment facility. We have a building for Level 2 and Level 3 patients. If they are in the state's custody, Level 3 clients' services are only billed to DCS. If they have private insurance, Level 3 client's...
  49. T

    Wiki Coding Behavioral Health Forms

    I am requesting opinions regarding what information from specific areas should be coded from Behavioral Health visit forms. Informational areas on the form are: Mental status, Medical symptoms (medical condition, medication, physical symptoms), Behavioral history, Substance use, eating habits...
    • torresreb
    • Thread
    • behavioral health medical-coding mental health
    • Replies: 0
    • Forum: ICD-10
  50. C

    Wiki Help with Psych ICD-9 Sequencing & COnsults

    I am a coding compliance auditor (no boos, please!) and I have recently inherited a psychiatry group. I have absolutely no experience with psych coding at all, and the availablity of any resources on the subject are positively underwhelming! I have 1 main question: Our psychiatrists do a lot...
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