CPT Codes For Mental Health Professionals

Sep
2
2014

In 1991, I jumped off into private practice and eagerly signed up to join as many managed care panels as I could.  (I’m not recommending the “jumping off” or joining all those panels.  But, if you’ve been following this blog for a while, you already know that.) 

One of the most confounding things that I was confronted with were CPT codes.  No one in graduate school talked about “CPT codes.”  No one in any of the agencies I had worked in  ever talked to me about those mysterious codes.  And, no one in the for profit psych hospital I had just left ever mentioned those codes to me . . . . 

Yet, I still thought I was just supposed to magically know about them so I tried to fake it and “act as if” I knew what they were.  But, I didn’t have a clue.  Perhaps you’ve been in a similar situation?  

Of course, this was pre-internet days so I couldn’t hop online and ask Google “What is a CPT code? And, by the way, how do I use them?” 

Eventually, I found a therapist in the community who recognized that I was clueless and kindly shared a list of the 5 or 6 codes that she used most often.  It would be another handful of years before I realized that these codes were actually regulated and had very specific definitions that dictated when and and under what circumstances to use them.  (That was after I had run across and purchased a CPT code handbook for Psychiatrists!)  And, yes, I had been coding a few things wrong.

Fast forward two decades and I’m blogging away and keeping an eye out for a billing specialist who was interested in sharing some insights and advice with you guys. And, . . . voila!  Denny Chapin reached out to introduce himself and offered to share his insights on the use of CPT codes to help us out.  So, here’s a guest post by billing specialist Denny Chapin to clue you in!

  (If you are interested in writing a guest post, check out the guidelines here.)

  ________________

 A Guest Post by Denny Chapin

What are CPT Codes?

CPT (Current Procedural Terminology) is a standardized medical code set maintained by the American CPT Codes for Mental Health ProfessionalsMedical Association.

CPT codes are five-digit numeric codes describing everything from surgery to radiology to psychotherapy. For psychotherapists that are on managed care panels or provide superbills to their clients, knowing CPT codes is paramount to getting paid in full and avoiding insurance audits.

The amount insurance companies will reimburse depends on a number of different factors (professional credentials, geographic location, etc.), but using the correct CPT Code and add-on code(s) to express the exact service is an important part to the whole process in ultimately determining your payment.

Reporting Errors – Accidental and Otherwise

Errors, accidental or otherwise, will directly impact insurance company’s payment of services. Downcoding (including less services on the claim than actually provided) will usually mean you get paid less, while upcoding (including more services on the claim than actually provided) can get you in trouble with your managed care panels.

It’s also important to note that it might be tempting to maximize your CPT codes to earn higher reimbursements. This is highly recommended against and can get you flagged, audited and removed from insurance panels. Even if this is your biller’s error, the therapist is the one who ultimately bears the responsibility and will be the one penalized.

CPT Codes for Psychotherapy

CPT coding for psychotherapy doesn’t have to be difficult. There are an overwhelming number of total CPT codes (about 8,000).  However, only 24 are specifically designated for psychotherapy. To make matters even simpler, nearly all therapists will regularly use an even smaller subset of these 24 codes. CPT codes change from year to year but the psychotherapy codes seldom change. Prior to the change in  2013, the last change in psychotherapy coding was in 1998. In other words, it’s likely that you will only need to learn them once.

CPT Add-On Codes

A CPT add-on code is a code describing a service performed in conjunction with a primary service. Many of these add-on codes are associated with a specific CPT code or a small subset of CPT codes and cannot be used without those particular codes. For example, the CPT code for interactive complexity (+90785) can be used for a diagnostic (90791, 90792) or a normal psychotherapy session (90832, 90834, 90837) but not a crisis psychotherapy session (90839).

Add-on codes are identified by a + sign in front of the number, i.e. +90840 is an add-on code for extra time in the case of crisis psychotherapy. On CMS 1500 forms CPT add-on codes are simply added on a new line.

Criteria for Interactive Complexity (+90785)

Interactive Complexity (+90785)  is one of the new add-on codes in the 2013 update.  This code is used as an umbrella add-on code and can be used for four different criteria. The most common scenarios typically involve children, although this is not always the case.

Examples of Interactive Complexity include the following:

  • the use of play equipment with young children,
  • interpreters / translators,
  • involvement of parents with discordant views that complicate the treatment plan, and
  • the reporting of abuse / neglect.

Note that interactive complexity can be used in conjunction with primary CPT codes for diagnostics, psychotherapy, or group therapy but cannot be used for couples / family therapy or crisis codes.  You may download this pdf for additional information on how to use the interactive complexity code in billing.

How Do CPT Codes Affect Reimbursement?

Many therapists question whether or not they are being paid the correct amount.  Here are typical rates for reimbursement contingent upon your credentials:

Typical Reimbursements by Type of Therapist

Image of Reimbursement Rate by Credential

Rates for reimbursement can vary significantly from therapist to therapist but these figures (above) are good benchmarks for comparison. The way CPT codes affect reimbursement is complicated and depends on a therapist’s level of education, location, and license. The AMA has created a code search feature on their website that shows payments based off CPT code and location. This information is somewhat incomplete, is based off medicare payments and does not specify a number of other important factors. However, this tool is still very useful to compare the relative value CPT codes against one another. Private insurance will be correlated with some deviation from these numbers.

 Reimbursement by CPT Code (Three Different Geographies)

Screen Shot 2014-08-29 at 4.05.58 PMData (above) from AMA Codemanager

 Key Points on The Use of CPT Codes

  • Don’t worry about memorizing all the CPT codes (there’s a lot!) or even all of the mental health ones.
  • It’s likely that you will only use a few individual codes on a regular basis.
  • If you are just starting out in private practice or just beginning to deal with managed care, keep it simple.
  • CPT codes appear far more complex from the outside looking in.
  • Here is a CPT Cheat Sheet to help you out.
  • And, here is a blog post telling you How and Where to Look Up CPT codes for free!
  • Memorize the relevant codes and use Google or other references to find the correct CPT codes for more unique scenarios.

And, finally, if you can’t figure out what you’re looking for, just ask!

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About the Author:  Denny Chapin is a billing specialist. He runs Image of Denny ChapinTheraThink, a private billing company specializing in billing for therapists, that is dedicated to make billing and dealing with insurance companies as simple and pain-free as possible!

 

 

 

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Shattering The Silence Around Suicide Is Part Of Your Job

Aug
15
2014

Robin Williams died this week and it reminded me yet again of how easy it is to make a life and death difference in someone’s life and yet how difficult it can be for us to consciously choose to actually do so.

Check out this TedTalk video shared this week by Lauren Ostrowski.

As licensed mental health professionals, we are required to shatter the silence around suicide by starting conversations that matter – not just with our clients but also with our neighbors, our friends, and our family members.

That’s part of the advocacy that we are mandated to engage in.

What I know is that most people who are thinking about suicide never speak to a health care professional . . . not ever . . . even if they already have an ongoing professional relationship with a mental health professional.

Instead, most people thinking about suicide choose to talk to a friend . . . or a family member . . . or even a colleague.

Mental health professionals are not their first choice.

That means that you mother or your child or your partner or your sibling is much more likely to hear someone talking about suicide today than you are in your own office.

As you are thinking about the silence that surrounds suicide today, ask yourself these questions . . . .

  • What are you doing to prepare those around you for that conversation?
  • When did you last initiate a conversation about suicide with someone outside of your work setting?
  • Why is that?  (That reason matters.)
  • And, what is it you are willing to do today to be better prepared to have another (conversation) that matters?

If the words “Are you thinking about killing yourself?” stick in your throat . . . .

If you’ve never asked someone about suicide . . . .

Please consider getting trained in Applied Suicide Intervention Skills Training through LifeWorks now.

It’s time . . . to shatter the silence. 

It’s your job.

 

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APA Formatting For Your Citations: Blog Posts, Facebook Updates, YouTube, and More

Aug
14
2014

Several of you have asked where you can go to get the correct APA formatting for your blog posts, Facebook updates, etc.  Here’s 4 online resources to help you get it right every time.

 If you have other favorite resources to add to this list, please do so!

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