Behavioral Health Billing and Coding for New Practices

Behavioral Health Billing and Coding for New Practices (an article by PrimeCare MBS)

Behavioral Health Billing and Coding for New Practices

Introduction

Starting a new behavioral health practice involves navigating lots of administrative tasks, one of the most crucial being the billing and coding process. Proper billing and coding ensure that your practice gets reimbursed accurately and promptly, reducing the risk of claim denials and improving cash flow. PrimeCare MBS, a reliable medical billing company, has provided this comprehensive guide on behavioral health billing and coding for new practices. It will help you understand the essentials and streamline your financial operations.

Understanding Behavioral Health Billing

Behavioral health billing refers to the process of submitting claims to insurance companies for services provided by mental health professionals, including psychiatrists, psychologists, therapists, and counselors. Accurate billing is essential for getting reimbursed for services rendered and requires a thorough understanding of the relevant codes and payer requirements.

Key Steps in Behavioral Health Billing

  • Patient Registration: Collect and verify patient information, including insurance details. Ensure accurate entry of demographic and insurance data into your billing system.
  • Insurance Verification: Confirm patient eligibility and benefits before the first appointment. Determine coverage specifics, such as copays, deductibles, and any prior authorization requirements.
  • Service Documentation: Maintain detailed and accurate clinical notes that support the services billed. Ensure documentation meets the payer’s guidelines for medical necessity.
  • Coding Services: Use appropriate CPT (Current Procedural Terminology) and ICD-10 (International Classification of Diseases, Tenth Revision) codes. Apply HCPCS (Healthcare Common Procedure Coding System) codes where necessary.
  • Claim Submission: Submit claims electronically to the appropriate payer. Follow up on unpaid claims and address denials promptly.

Essential Codes for Behavioral Health Billing

CPT codes describe the procedures and services provided during a patient encounter. Some commonly used CPT codes in behavioral health include:

  • 90791: Psychiatric diagnostic evaluation without medical services.
  • 90792: Psychiatric diagnostic evaluation with medical services.
  • 90832: Psychotherapy, 30 minutes with patient.
  • 90834: Psychotherapy, 45 minutes with patient.
  • 90837: Psychotherapy, 60 minutes with patient.
  • 90846: Family psychotherapy without the patient present.
  • 90847: Family psychotherapy with the patient present.
  • 96127: Brief emotional/behavioral assessment (e.g., depression inventory).

ICD-10 codes classify diagnoses and symptoms. Common behavioral health ICD-10 codes include:

  • F32.0: Major depressive disorder, single episode, mild.
  • F32.1: Major depressive disorder, single episode, moderate.
  • F41.1: Generalized anxiety disorder.
  • F43.10: Post-traumatic stress disorder, unspecified.
  • F84.0: Autism spectrum disorder.

HCPCS codes may be used for certain services and supplies not covered by CPT codes, such as:

  • H0031: Mental health assessment by non-physician.
  • H2011: Crisis intervention service, per 15 minutes.
  • T1015: Clinic visit/encounter, all-inclusive.

Tips for Accurate Behavioral Health Coding

  • Stay Current with Coding Changes: Regularly review updates to CPT, ICD-10, and HCPCS codes. Subscribe to industry newsletters and attend coding workshops.
  • Ensure Thorough Documentation: Detailed documentation is crucial for justifying the services billed. Record the time spent on each service and the specific interventions used.
  • Verify Payer Requirements: Different insurers may have varying requirements for billing and documentation. Check payer policies regularly to ensure compliance.
  • Use Modifiers Appropriately: Modifiers provide additional information about the service performed. Common modifiers in behavioral health include GT (via interactive audio and video telecommunication systems) and 25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).

To conclude,

Behavioral health billing and coding for new practices can be complex, but with the right knowledge and tools, you can navigate this critical aspect of your business effectively. By understanding the key steps, using appropriate codes, ensuring thorough documentation, and leveraging technology, your practice can achieve accurate and timely reimbursements. Staying updated with industry changes and continuously refining your billing processes will contribute to the financial health and success of your practice.

CPT® (Current Procedural Terminology) codes are the copyrighted property of the American Medical Association (AMA). The use of CPT® codes in this article is intended solely for informational purposes to facilitate accurate billing and coding for healthcare providers. For detailed information and official guidelines, please refer to the American Medical Association’s website.

This article is for educational purposes only and does not substitute professional training or certification in medical billing and coding.

Share this post

Author