Analytic and Procedural Coding

Presentation Transcript

Analytic and Procedural Coding

Objective To enhance demonstrative and procedural coding for emotional well-being screening, appraisal, referral, and mediation

How would you report psychological well-being administrations? Who reports emotional wellness administrations? Where are emotional wellness administrations archived? (emotional wellness outline, restorative record, both graphs, log sheet, database, experience shape) How do psychological wellness suppliers and essential care suppliers share data about emotional well-being administrations?

What we'll cover… Why code? General Coding Principles Mental Health Diagnostic Codes Mental Health Procedural Codes Reimbursement Who can charge? Misrepresentation and Abuse Work arrange recommendations

Why Code???

"We can't charge for psychological wellness administrations, so why code?" You ought to in any case archive keeping in mind the end goal to: Justify your position Assess emotional wellness issues of school populace Track treatment Track consistence Assist in measuring results Demonstrate a requirement for psychological well-being repayment

Why Code Correctly ? Repayment relies on upon administrations portrayed by CPT codes- - coding is the reason for repayment Diagnosis codes bolster medicinal need for administrations conveyed Understanding coding presumptions and rules helps suppliers to enhance repayment Providers must set up trustworthiness in the human services framework Document need administrations Illustrate multifaceted nature of administrations

General Coding Principles

General Coding Principles The motivation behind codes is to report administrations gave Documented administrations are probably going to be paid Services not recorded "never happened" Never "upcode" with the end goal of getting more cash Most likely, you are undercoding

General Coding Principles (cont.) You should dependably have both! Two Part Coding Process CPT – "What you do" ICD – "Why you do it" Diagnosis codes (ICD) must bolster system codes (CPT)

General Coding Principles (cont.) Primary Steps for Coding an Encounter: Provider picks technique code (CPT) from experience frame or superbill Provider notes finding, which is coordinated to an analysis code (ICD)

Documentation Where to report codes? Experience Form Database BOTH (if particular): emotional wellness graph AND medicinal record

Mental Health Diagnostic Codes

Coding Systems ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification)/DSM-IV-TR (Diagnostic and Statistical Manual – Fourth Edition – Text Revised) * utilized by human services experts to group persistent sicknesses, wounds, and hazard components.

Anxiety Disorders 300.01 Panic Disorder Without Agoraphobia 300.21 Panic Disorder With Agoraphobia 300.22 Agoraphobia Without History of Panic Disorder 300.29 Specific Phobia Specify sort: Animal Type/Natural Environment Type/Blood-Injection-Injury Type/Situational Type/Other Type 300.23 Social Phobia Specify if Generalized 300.3Obsessive-Compulsive Disorder Specify if With Poor understanding 309.81 Posttraumatic Stress Disorder Specify if Acute/Chronic Specify if With Delayed Onset 308.3 Acute Stress Disorder 300.02Generalized Anxiety Disorder 300.00Anxiety Disorder NOS

Depressive Disorders 296.xx Major Depressive Disorder .2x Single Episode .3x Recurrent 300.4 Dysthymic Disorder Specify if Early Onset/Late Onset Specify With Atypical Features 311 Depressive Disorder NOS

Disruptive Behavior Disorders 314.xx Attention-Deficit/Hyperactivity Disorder .01 Combined Type .00 Predominantly Inattentive Type .01 Predominantly Hyperactive-Impulsive Type 314.9 Attention-Deficit/Hyperactivity Disorder NOS 312.xx Conduct Disorder .81 Childhood-Onset Type .82 Adolescent-Onset Type .89 Unspecified Onset 313.81 Oppositional Defiant Disorder 312.9 Disruptive Behavior Disorder NOS

Substance Abuse/Dependence 303.90 Alcohol Dependence/305.00 Alcohol Abuse 304.00Amphetamine Dependence/305.70 Amphetamine Abuse 304.30 Cannabis Dependence/305.20 Cannabis Abuse 304.20 Cocaine Dependence/305.60 Cocaine Abuse 304.50 Hallucinogen Dependence/305.30 Hallucinogen Abuse 304.60 Inhalant Dependence/305.90 Inhalant Abuse 305.1 Nicotine Dependence 304.00 Opioid Dependence/305.50 Opioid Abuse 304.60 Phencyclidine Dependence/305.90 Phencyclidine Abuse 304.10 Sedative, Hypnotic, or Anxiolytic Dependence/305.40 Sedative, Hypnotic, or Anxiolytic Abuse 304.80 Polysubstance Dependence 304.90 Other (or Unknown) Substance Dependence 305.90 Other (or Unknown) Substance Abuse The taking after specifiers apply to Substance Dependence as noted: With Psychological Dependence/Without Psychological Dependence Early Full Remission/Early Partial Remission/Sustained Full Remission/Sustained Partial Remission In a Contained Environment On Agonist Therapy

Documentation of Diagnostic Codes Report the full ICD-9-CM code for the determination appeared to be essentially in charge of the outpatient administrations. Suppliers ought to report the determination to their most elevated level of conviction .

Mental Health Procedural Codes

Coding Systems CPT (Current Procedural Terminology) - codes that prevalently depict administrations & methods. They give a typical charging dialect that suppliers and payers can use for installment purposes.

Evaluation & Management (E&M) Codes 99201 – 99215 New and Established Patient Office Visits 99241 - 99245 Consultations 99361 - 99362 Case Management Services, Team Conferences 99371 - 99373 Case Management Services, Telephonic

Mental Health Procedure Codes 90801 - 90802 Psychiatric Diagnostic or Evaluative Interview Procedures 90804 - 90829 Psychotherapy 90804 - 90815 Office or Other Outpatient Facility 90810 - 90815 Interactive Psychotherapy 90816 - 90829 Inpatient Hospital, Partial Hospital or Residential Care Facility 90845 - 90857 Other Psychotherapy 90862 - 90889 Other Psychiatric Services or Procedures

Psychiatric Therapeutic Procedures CPT Codes 90804 – 90889 Psychotherapy is the treatment for maladjustment and behavioral unsettling influences in which the clinician builds up an expert contract with the patient and, through authoritative helpful correspondence, endeavors to mitigate the passionate aggravations, turn around or change maladaptive examples of conduct, and energize identity development and improvement.

E&M Codes and MH Codes The Evaluation and Management administrations ought not be accounted for independently, when revealing codes: 90805, 90807, 90809, 90811, 90813, 90815, 90817, 90819, 90822, 90824, 90827, 90829.

Reimbursement Who can charge? Extortion and Abuse

Who can charge? What are the principles overseeing who can charge for emotional well-being finding/treatment in your state?

Who Can Bill? Who can charge for behavioral wellbeing administrations? Most states acknowledge doctors, Clinician Psychologists (CP), Licensed Clinical Social Workers (LCSW) However, each State has its own particular guidelines and many will pay for different experts

Coverage Issues A supplier ought to recognize what administrations are secured. Administrations must be recorded and medicinally vital with the goal for installment to be made. Do you, as a supplier, know whether all administrations gave are secured? Is it accurate to say that you are recording appropriately, and shouldn't something be said about this "medicinally essential" piece?

How Much would you say you are Paid? Repayment Reductions in repayment rates by supplier sort Physician -not marked down Clinical Psychologist -reduced LCSW -additionally marked down Other -marked down if covered

Reimbursement Issues E&M codes are constrained to doctors, Pas, NPs, attendants Same is valid for 90805, 90807, 90809 codes An E&M (992XX) and a treatment (908XX) can't be charged on a similar date of administration to most Medicaid projects

Documentation and Coding: Fraud and Abuse Services MUST be therapeutically essential (dictated by payers in light of a survey of administrations charged) Music, diversion, instrument, pet association treatments, sing-alongs, expressions and makes, and other comparative exercises ought not be charged as gathering or individual exercises. Administrations performed by a non-authorized supplier especially as "episode to" utilizing the PIN of the authorized supplier

Elements of "Occurrence To" An indispensable piece of the doctor's proficient administration Commonly rendered without charge or for the most part not ordered independently in the doctor's bill Of a sort that are normally outfitted in doctor's office or center Furnished under the doctor's immediate individual supervision

Work arrange Suggestions

Actions Step: Review Program Services Define the Behavioral/Mental Health Services your understudies are getting Determine if there are extra Behavioral/Mental Health Services you need to give

Action Step: Review and Modify Encounter Form Does experience shape incorporate both indicative and procedural codes that would be utilized for behavioral wellbeing when conveyed by essential care suppliers? Emotional well-being suppliers? Do procedural codes speak to all administrations gave (counting those not charged for)? Do analytic codes speak to all symptomatic classifications (counting those not charged for)?

Action Step: Review and Modify Documentation Procedures Are analytic and technique codes recorded for in each advance note? Are codes for each experience reported in both the SBHC medicinal record and psychological wellness diagram (if independent)? Are codes gone into database paying little mind to repayment?

Action Step: Understand State Program and Provider Coverage Issues Research State Program Information www.cms.gov (Medicare Regulations) Search by state by Department of Health or Department of Mental Health to discover state particular inf