Psychotherapy Medical Billing & Coding Guide for 2023

With ICANotes, you can worry less about getting your documentation right and spend more time with your patients. We offer a solution to the many complexities in the healthcare environment that make your job more difficult. ICANotes is the premier EHR for behavioral health specialty, and we work with all clinical disciplines to deliver an intuitive charting solution for your practice. The HN modifier is used to identify mental health services provided by professionals holding a Bachelor’s degree in a related field, such as psychology or social work.

The UB-04 and other mental health forms are uploaded on some compliant software programs, making it easier for you to electronically fill out and file the form. As a mental healthcare provider, you can do everything right up until you submit a claim, but all of your hard work will be undone if you don’t do it properly. For instance, after you provide a service, you should expect to receive a reimbursement from a claim.

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In the context of mental health, however, it simply describes a different session of treatment and nothing more. Are you worried about receiving and validating all the necessary info for your psychotherapy services on time? Consider these custom online fillable forms from Practice Tech Solutions. Psychotherapy documentation in addtion to treatment strategy used to modifiy family behavior and attitudes. Psychiatric diagnostic evaluation is an integrated biopsychosocial assessment, including history, mental status, and recommendations.

Modifiers on insurance claims are codes that tell the insurance company how a procedure or service was done differently than normal. They help show the insurance company what services were provided and how much to pay for those services. Common modifiers include mental health billing codes for how many times a service was done, what setting it was done in, what type of professional did it, and what device or approach was used. Benefits of using modifiers include more accurate payments and improved efficiency in processing claims.

— Under preventive medicine, individual counseling services

Using modifiers on insurance claims helps make sure that providers get the right amount of money for the services they provided. It also helps to make sure that the services are reported accurately and that fraud and abuse are prevented. There are even more CPT codes, but mental health practitioners will mostly use the codes that start with digit 9.

• It is not necessary that a course of therapy have as its goal restoration of the patient to the level of functioning exhibited prior to the onset of the illness, although this may be appropriate for some patients.
• The list of results will include documents which contain the code you entered.
• Do not report the CPT add-on code for Interactive Complexity code in conjunction with Psychotherapy for crisis codes or in conjunction with E/M services when no psychotherapy service is also reported.
• This is another area where we recommend contacting or researching ahead of time before filing a claim.
• Enter the code you’re looking for in the “Enter keyword, code, or document ID” box.

Psychotherapy codes that include an evaluation and management component are payable only to physicians, NPs and CNSs. The evaluation and management component of the services must be documented in the record. A psychotherapy code should not be billed when the service is not primarily a psychotherapy service, that is, when the service could be more accurately described by an evaluation and management or other code. Another tip for submitting claims properly is to familiarize yourself with common claims forms that many insurance companies use, such as the UB-04 form. This form is usually reserved for mental health clinics and specialized health centers for medical billing.

HCPCS Code Modifiers

Medicare Part A covers psychiatric hospitalization up to 190 days, while Medicare Part B covers what is essentially a “day” program – it will not cover long-term hospitalization or institutional care.

However, if you file an incorrect code or accidentally file it to the wrong insurer, you can be denied or run into other billing issues. This is yet one more reason why mental health providers choose billing services like TheraThink to help. This guide will teach you how to bill for multiple mental health services on the same date of service using the correct same day modifier. It is simply a general description of commonly performed mental health services. Psychiatrists treat diverse conditions such as anxiety, depression, schizophrenia, bipolar disorder, anorexia, substance abuse, ADHD, OCD, and PTSD. Billing mental health services is different from billing medical conditions.

It’s important to note that each insurance company may have specific requirements and policies regarding the use of these and other modifiers for behavioral health billing. The AJ modifier is used to identify services provided by a Licensed Clinical Social Worker (LCSW). LCSWs are mental health professionals who have obtained the necessary education, training, and licensure to provide psychotherapy and other mental health services.

However, the healthcare professional must maintain adequate documentation for each encounter. As such, psychotherapy medical billing guidelines are also more important than ever. Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. Unless specified in the article, services reported under other
Revenue Codes are equally subject to this coverage determination.

Undercoding is when a CPT code represents a less severe diagnosis or lower-priced treatment than was actually given to a patient. Though this practice is often done intentionally to help save patients money for their services, it is illegal. General Coding Psychiatry and Psychology are specialized fields for the diagnosis and treatment of various mental health disorders and/or diseases. Behavioral health medical billing demands accuracy from the documentation that ultimately dictates the codes and modifiers that will generate reimbursement. Common modifiers range from a discontinued procedure to service expectations not being met.

(Or, for DME MACs only, look for an LCD.) Review the article, in particular the Coding Information section. Keep up on our always evolving healthcare industry rules and regulations and industry updates. Plans are insured or covered by a Medicare Advantage organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare.

Revenue Codes

The HP modifier is used to identify mental health services provided by psychologists or professionals with a doctorate-level degree (PsyD or Ph.D.). Psychologists have undergone extensive education and training in psychology and are qualified https://www.bookstime.com/articles/accounting to provide a wide range of mental health services, including assessment, diagnosis, and therapy. Modifiers are codes or symbols used to provide additional information about a service or procedure performed by healthcare providers.