CPT codes simplify medical billing across domains and practice types, providing reimbursement for a broad range of health-care specialists, including mental health practitioners. Memorizing and applying the appropriate codes can help to speed up the billing process and optimize reimbursement. But applying the right CPT codes for medical billing requires comprehending a complex process.
There are numerous codes to pick from and several distinct rules to abide by. However, utilizing medical codes correctly and getting the highest reimbursement rates for your offerings is possible. In this post, we’ll go over how to use CPT codes and the top CPT codes used by behavioral health billing providers.
What Are CPT Codes?
CPT codes are a standardized classification scheme for medical services created by the American Medical Association (AMA). The AMA developed this system in 1966 to standardize vocabulary and make record-keeping easier for physicians and personnel. CPT has experienced various revisions since its inception. The most current version focuses on reporting physician services using CPT codes.
CPT codes reflect medical operations done on a patient by a physician, such as testing, assessments, surgeries, and other treatments. For example, CPT codes for behavioral health specify the duration of a psychotherapy consultation with a patient or a diagnostic assessment. CPT codes are required to be reimbursed by health insurance companies.
Categories of CPT Codes
CPT codes are classified into several categories.
The majority of healthcare professionals in Category I use the five-digit CPT codes. This code is the most commonly used since it identifies particular, well-established operations. These codes are divided into segments depending on the field of healthcare. The CPT codebook is divided into six sections: Evaluation and Management, Medicine, Surgery, Radiology, Anesthesiology and Pathology, and Laboratory. Each has its own set of rules.
Category II codes aren’t necessary for billing purposes; they’re used to collect performance measurement data and care quality. Category II codes consist of four digits, preceded by the letter F. They are optional, offer more details, and do not take the place of Category I or Category III codes.
Category III codes are used for new approaches and technologies. They were developed for data gathering and assessment, as well as, in certain situations, payment of new services that do not fit the criteria for Category I codes. If you can’t locate a new practice in Category I, you may try a Category III code. Category III codes are four digits and begin with the letter T.
CPT codes also have several modifiers. Modifiers are two numbers or letters that can be added to a CPT code. They define precise steps in a method.
Some codes include directives in parentheses below them to inform the programmer that there may be a more superior code to use. Codes must be as descriptive as possible for a behavioral health billing claim to be recognized.
Common Behavioral Health Billing CPT Codes
Each practice is unique. Identifying the most commonly used codes will help you save time and ensure proper billing. Some popular examples of behavioral health billing codes are:
90791: Evaluation of a psychiatric diagnosis in the absence of medical care. This code does not have a time range. A background, mental status, and prescription are all part of the psychiatric diagnostic examination. It may involve talking to family members and getting information from other sources, but psychotherapy services are not included. It may be used more than once for an initial evaluation if additional time is required, but only once per patient per day.
90832: 30 minutes of psychotherapy. Psychotherapy is a familiar procedure in behavioral health. Code 90832 denotes services for the client’s personal psychotherapy, which may also involve an informant. Services include continuing evaluation and modification of therapeutic strategies. This service is often provided by professional psychologists and licensed clinical social workers.
90834: 45 minutes of individual psychotherapy in an outpatient environment. Individual treatment sessions coded with 90834 must typically last between 38 and 52 minutes.
90837: 60 minutes of insight-oriented, behavior-modifying, and/or supportive individual psychotherapy with the patient and/or a family member
90847: The code 90847 refers to family psychotherapy with the client present. When you give independent, different individual treatment, you can utilize it on the same day as individual psychotherapy. 90847 has a session length of 50 minutes, and the actual service period must be 26 minutes or longer. 90846 is family psychotherapy in which the client is not present. It adheres to the same time constraints and billing guidelines as 90847.
90853: Group psychotherapy apart from a multiple-family group. The pathology of each individual inside the group is examined via the interactions of group members. The dynamics of the entire group are observed and used as a guide to change the client members’ actions and attitudes. (Used to evaluate each group member’s per-session offerings.) There is no time specified in this code.
90875: The practitioner performs 30 minutes of psychophysiological treatment employing biofeedback training in conjunction with psychotherapy to change the patient’s behavior. Individual psychophysiological treatment combines any modality of biofeedback training (face-to-face with the client) with psychotherapy, such as insight-oriented, behavior-modifying, or supportive psychotherapy.
90838: Individual psychotherapy for 60 minutes with the client and/or a family member when administered in conjunction with an assessment and management (E/M) service.
99404: 60 minutes of psychotherapy. Individuals receive preventive medicine advice and/or risk factor reduction intervention(s) (separate procedure).
How to Use Logik Solutions to Maximize Reimbursement and Avoid Insurance Claim Denials
If you wish to prevent claims problems, keep in mind that the degree of service to the bill is determined by medical necessity. It is not essential to record a higher degree of service if it is not required. Always ensure that the paperwork supports the level of service for which you are invoicing. Your clinic or facility can improve operational efficiency while increasing income sources with the correct psychiatric billing tool—and maybe a skilled billing team.
Knowledge and practice are necessary for proper coding. Most behavioral health physicians prefer to devote their time and efforts to patient care rather than coding and billing. Allow Logik Solutions to step in and handle the job, so you can go back to doing what you love. We offer a safe, fully integrated solution that streamlines the claim procedure. Schedule a demo to learn more about mental health billing software that may improve your claims process and help your institution optimize compensation. You can also learn more about Logic by visiting our site and browsing features, services, and blogs.