2. 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

3. 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

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

5. 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

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

7. 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

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

9. 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

10. 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  90791 + 90785, Psych Dx Eval. with interactive complexity  90792 + 90785, Psych Dx Eval. with medical services and interactive complexity

11. Health & Behavior (H&B) Codes 96150 – 96155

12. Reimbursement Resources Medicare Links  http://www.cms.gov/Manuals/IOM/list.asp http://www.cms.gov/Manuals/IOM/list.asp  http://www.cms.gov/Transmittals/01_overview.asp http://www.cms.gov/Transmittals/01_overview.asp  Medicare Documentation Guidelines for Evaluation and Managements Services 95 & 97 http://www.cms.gov/MLNEdWebGuide/25_EMDOC.asp http://www.cms.gov/MLNEdWebGuide/25_EMDOC.asp  NHIC http://www.medicarenhic.com/http://www.medicarenhic.com/  CMS National Correct Coding Initiative http://www.cms.gov/Medicare/Coding/NationalCorrectCodInit Ed/index.html/nationalcorrectcodinited Other  www.mehaf.org – Maine Health Access Foundation www.mehaf.org  www.ibhp.org – Integrated Behavioral Health Project www.ibhp.org  www.mainehealth.org/behavioralhealthintegration www.mainehealth.org/behavioralhealthintegration  www.thenationalcouncil.org – the National Council for Community Behavioral Healthcare www.thenationalcouncil.org

13. Contacts Mary Jean Mork, LCSW Program Director MaineHealth and Maine Behavioral Healthcare 110 Free St. Portland, Maine 04101 morkm@mmc.orgmorkm@mmc.org, 207-662-2490