Mental Health Billing - A Guide

What are the special needs of a mental health biller and coder?

A healthy mind is part of a healthy body. As such, most insurance companies cover mental health services, as long as they are considered medically necessary.

For example, Medicare Part B will cover mental health services as long as they are medically necessary for the diagnosis or treatment of an illness or injury.

This means that medical insurance will cover mental health services, but only to a certain extent. Medical insurances are very stringent on the types of mental health benefits they provide, so if you are billing for a mental health professional, you need to be very careful.

Who can provide mental health services?

One of the first regulations of mental health billing is the provider of service. This means that insurance will only cover mental health services if they are provided by a certain type of mental health provider.

For example, Medicare allows the following providers to bill for diagnostic and therapeutic treatment:

  • Physicians,
  • Psychiatrists,
  • Clinical psychologists,
  • Clinical social workers,
  • Clinical nurse specialists,
  • Nurse practitioners,
  • and Physician assistants.

These providers can only bill for mental, psychoneurotic, and personality disorders.

Mental Health Billing

On the other hand, independent psychologists and non-clinical psychologists can only provide diagnostic services.

What this means is that Medicare will only pay an independent psychologist to diagnose a patient with a mental disorder, and not to continue treating the patient with the mental disorder. If you are a physician or psychiatrist, on the other hand, Medicare will pay for you to diagnose and treat the patient with the mental disorder.

Types of covered mental health services

Mental health services are all similar, due to the fact that they are almost all performed as a type of counselling service. Because of this, there is not a very large amount of codes that you can bill for mental health services.

The types of covered mental health services are:

Psychiatric Diagnostic Interview

This interview is an examination of the patient's entire medical and mental health history, completion of a mental health status exam, an establishment of a provisional diagnosis, and an evaluation of the patient's willingness and ability to help solve the mental health problem.

When this interview is performed on children, it is performed using physical aids and non-verbal communication, such as with play equipment.

The two codes that are reported for these services are:

  • 90801: Psychiatric diagnostic interview examination
  • 90802: Interactive psychiatric diagnostic interview examination

Psychiatric Therapeutic Services

Individual psycho-therapy is rendered to people who have the ability to understand and respond meaningfully to a provider's questions and comments. This communication is meant to help get rid of emotional disturbances, change patterns of behavior, and help the individual live a more normal healthy life.

These codes represent what most people think of as therapy by a psychiatrist.

When your provider reports these codes, you have to keep in mind the type of psychotherapy, the place of treatment, the time spent with the patient, and whether an examination was also provided on the same date of service.

The code ranges for these services are:
  • 90804-90809: Insight-oriented, behavior modifying and/or supportive psychotherapy
  • 90810-90815: Interactive psychotherapy

Family Medical Psychotherapy

Sometimes, a therapist or psychiatrist will provide therapy sessions to a patient's family, whether or not the patient is actually present. This service is sometimes considered for payment by the insurance company, depending on the situation, and documentation that it was a medically necessary service.

These services are provided to help the patient's family understand the patient's condition and to educate them on how to help the patient alleviate their condition, or to help them create and stick to a plan of care.

One of the important things to remember about Family Psychotherapy is that in order for the service to be covered, the group being counselled must meet the definition of family. That is, immediate family members, such as spouse, child(ren), grandchild(ren), parents, grandparents, or primary caregivers or health care proxy.

The code ranges for these services are:

  • 90846: Family psychotherapy (without the patient present)
  • 90847: Family psychotherapy (with the patient present)
  • 90849: Multiple-family group psychotherapy

Group Psychotherapy

In group psychotherapy, a provider selects a specific group of patients to treat together as a group, for the purpose of helping all members of the group change patterns of behaviour.

The code ranges for these services include:

  • 90853: Group psychotherapy (other than a multiple-family group)
  • 90857: Interactive group psychotherapy

As long as all of the mental diagnoses are considered treatable, and that the mental health service is considered medically necessary, then the medical insurance should pay for the mental health services as listed above.

Medical Record Documentation

Another important aspect of mental health billing is making sure that everything is properly documented in the medical record. This record is the basis of everything that is billed for the date of service, so it has to have all of the required documentation in order to support the procedure code that is billed.

Some of basic things that need to be included in this documentation are:

  • Reason for the encounter and relevant history
  • Physical exam findings and prior diagnostic test results
  • Assessment, clinical impression, and diagnosis
  • Plan of care
  • Date and identity of observer

Other things that need to be documented are:

  • The rationale for ordering services
  • Past and present diagnoses
  • Identification of health-risk factors
  • Patient's progress, response to treatment, and any revision of the diagnosis

If the medical record is incomplete, then there will be no basis for medical necessity, which means that the insurance company will not pay for the service.

Diagnosis coding considerations

One other consideration that has to be kept in mind is the diagnosis code itself. There is an entire chapter in the ICD-9 (diagnosis) coding manual, which deals with mental health diagnoses. There is also another book, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), which deals specifically with mental health diagnoses.

Even though the DSM-IV deals especially with mental health diagnosis codes, it does not mean that you shouldn't reference the ICD-9 coding manual. The ICD-9 manual contains the recognized code sets and guidelines for all reimbursable services and still needs to be used in the mental health coding field.

Mental health billing and coding is similar to medical billing and coding, and your services will be paid for by insurance companies as long as your diagnosis and treatments are considered medically necessary.

As long as you have all your ducks in a row and make sure that your provider is qualified to perform the mental health service before the service is performed, you won't have any surprise rejections, denials, or non-covered services.

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