Maximizing Reimbursement in Today’s Fee for Service World Part 2: The Codes Mary Jean Mork, LCSW October 27, 2014 Series offered through the support of the Maine Health Access Foundation

Objectives: The Codes Participants will be able to:  Describe the mental health and Health and Behavior codes generally used by integrated clinicians  Identify how the codes are accepted by various payers  Identify key questions for reimbursement Disclaimer for the series:  This information does not represent how a payer might respond to a claim  This information does not replace any regulatory information  Always seek information from your own agency consultants regarding any billing and coding practices

I have these great staff but: Who can get reimbursed for services in medical practices? Masters level clinicians Psychologists NPs/PAs

Master Level Clinicians  Medicare - LCSWs only, and only the mental health codes  Medicaid differs state to state and may allow: LCSWs, LCPCs and LMFTs, as well as conditional. May vary by practice type.  Commercials may also differ but generally more inclusive

Psychologists  Medicare reimburses both mental health and Health and Behavior codes  Generally paid by Medicaid and Commercial insurers

Psych NPs/PAs  Need to follow rules for E/M codes  Generally paid by all payers  Would probably not bill Health and Behavior codes  Often confusion around “medical” vs. “behavioral” credentialing with the commercial insurers

We are working with patients with medical conditions: What codes should we use? Mental Health codes Health and Behavior codes E/M codes

Mental Health and Health and Behavior Codes Mental Health Codes  90791: Initial Assessment  90832, 90834, 90837: Individual Therapy  90846, 90847:Family Therapy  90853: Group Therapy Health and Behavior codes  96150: Assessment  96151: Reassessment  96152: Individual intervention  96153: Group intervention  96154:Family intervention

E/M codes and Psych NPs  90832, Psychotherapy with E/M, 30 mins (16- 37)  90834, Psychotherapy with E/M, 45 mins (38- 52)  90837, Psychotherapy with E/M, 60 mins (53 or more)  90791, Psychiatric Diagnostic (Dx) Eval.  90792, Psych Dx Eval. with medical services  , Psych Dx Eval. with interactive complexity  , Psych Dx Eval. with medical services and interactive complexity

Health & Behavior (H&B) Codes – 96155

Reimbursement Resources Medicare Links    Medicare Documentation Guidelines for Evaluation and Managements Services 95 &  NHIC  CMS National Correct Coding Initiative Ed/index.html/nationalcorrectcodinited Other  – Maine Health Access Foundation  – Integrated Behavioral Health Project   – the National Council for Community Behavioral Healthcare

Contacts Mary Jean Mork, LCSW Program Director MaineHealth and Maine Behavioral Healthcare 110 Free St. Portland, Maine