1. Coding and Billing in a Biofeedback Practice Ronald L. Rosenthal, Ph.D.

2. …authorization is not a guarantee of payment

3. Contextual Background  Federal Policy  State Statutes  Insurance Regulations/LMRP  Business Practices  Clinical & Theoretical Orientation

4. Practice Models (or how to get the money)  Third Party Reimbursement  Fee for Service  Mixed Collection Methods  Section 403(c)

5. Provider Panels  Restricts your ability to set fees  Can increase the number of patients

6. Billing Prerequisites  Procedure Code  Diagnostic Code

7. Diagnostic Coding  ICD-10 for physical disorders  DSM IV for psychological disorders

8. Procedure Codes  Primarily oriented to physicians and treatment of physical ailments  Current Procedual Terminology (CPT code book)

10. Biofeedback Codes  90911 Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry  90901 Biofeedback training by any modality

11. Biofeedback and Psychotherapy Combination Codes  90876 Individual psychophysiological therapy incorporating biofeedback training by any modality (face to face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy) 45-50 minutes

12. Retired Biofeedback Codes  Prior to 1997 (the Golden Age) there were multiple codes specific for modalities of biofeedback – 90900, 90902, 90904, 90906, 90908, 90910 and 90915.

13. Alternative Codes For Biofeedback  97112 Neuromuscular reeducation of movement, balance, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities.

14. Alternative Codes For Biofeedback  97532 Development of cognitive skills to improve attention, memory, problem solving, (includes compensatory training).  Formerly 97770

15. Health and Behavior Assessment And Intervention Codes These codes describe services to patients who present with established illnesses or symptoms, who are not diagnosed with mental illness, and may benefit from evaluations that focus on the biopsychosocial factors related to the patient’s physical health status.

16. Rationale: Specific Examples  Patient Adherence to Medical Treatment  Symptom Management & Expression  Health-promoting Behaviors  Health-related Risk-taking Behaviors  Overall Adjustment to Medical Illness

17. Overview of Codes  New Subsection  Six New Codes Assessment Intervention  Established Medical Illness or Diagnosis  Focus on Biopsychosocial Factors

18. Relative Values for Health & Behavior Codes  96150 Assessment RVU =.50  96151 Reassessment RVU =.48  96152 Intervention RVU =. 46  96153 Group RVU =.10  96154 Family (with pt) RVU =.45  96155 Family (w/o pt) RVU =.44

19. Reimbursement Rates and Relative Value Units (RVUs)  Three components Physician Work Practice Expense Liability Insurance

20. Relative Value Units and Reimbursment (2)  The RVU is multiplied by a conversion factor to determine payment  Biofeedback codes have modest RVUs

21. Neurofeedback Evaluation Codes  95816 Digital EEG recording  95957 Digital EEG analysis  99090 Reference EEG database access

22. Modes of Claim Submission  Electronic Transmission  Hard Copy--Mailed

23. Modes of Claim Submission  Electronic Transmission  Hard Copy--Mailed

24. Electronic Submission of Bills and HIPAA  Small offices are exempted from HIPAA compliance if they do not use electronic transmission of information.  HIPAA compliance mandated when an office engages in electronic transmission of information.

25. Problems with Biofeedback Codes  Not universally covered.  May require prior authorization.  Limitations on number of sessions.  Limitations on types of patients/disorders eligible for reimbursement.  Poor reimbursement rates.  Time consuming to get authorization.

26. Medicare and Biofeedback  Requires the use of a modifier (GP for physical therapy) for payment.  There is a cap on outpatient rehabilitation services (less than $2000/year).

27. Medicare and Biofeedback  Rehabilitation professionals are trying to have the cap eliminated (The Medicare Access to Rehabilitation Services Act of 2007).

28. Medicare and Biofeedback  Medicare standards often adopted by other insurance companies.  Coverage only for muscular retraining.  Excludes 90876.  Limited diagnostic codes eligible.  Payment is less than $45 regardless of the length of session for 90901.