Mental health billing is more complicated than other form of medical billing. The primary reason being lack of uniformity in billing procedure. Unlike a general practitioner, who has to use the same standardized tests and services, a mental healthcare practitioner has to deal with a broader variety of procedures. To top it, mental therapy consists of different approaches. Knowledge of how each differs from the other is critical to ensure error free billing submissions. Further, insurance providers are very inconsistent in providing “mainstream” coverage. This makes it mandatory for billers to have a fingertip knowledge of what is covered and what is not with respect to each provider. As a safe practice, most providers dial up the carriers which make the process time consuming. Even a patient’s willingness to participate in certain treatments can impact billing. Each of these factors add to the complexity of the billing process.

 

However, one of the common reasons for denials in mental healthcare is coding issues. This primarily include ‘up-coding’ or ‘down-coding’. Up-coded billing entails billing a service at a level higher than the prescribed level of the service performed, like documenting a 30- minute individual psychotherapy service billing as a 60-minute service.  Conversely, a down-coded service is about billing a service at a lower level than the actual level of the service performed like failure to provide supporting documentation to the exact specificity. This also includes failure to document timings. This leads to reimbursed for the lowest possible time period. 

 Did You Know Approximately about 18% of people ages 18- 54 in a given year, have an anxiety disorder in a given year.   

How can you avoid coding mistakes from happening? The key lies in understanding the codes and the subtle difference in the application. As insurance companies bank on CPT codes to decide on the amount of reimbursement knowing codes is critical to ensure billing accuracy. Besides, repeated wrong usage of coding can lead to an investigation for abuse or fraud. It may invite needless audits that can lead to fines because of errors. Here are some common coding mistakes that you must try to avoid.

Common Mental Health Coding Errors & Remedies

Using the wrong CPT code 

This is always a possibility because procedural codes are very specific and choosing the right one can be confusing. For instance, diagnosis disorder 300.00 represents anxiety disorder and 300.02 represents generalized anxiety disorder, therefore not understanding the subtle difference can lead to a denied claim. Therefore, there is no substitute to a thorough understanding of the most common codes.

  Did You Know The major mental depression in the US are manic depression (also known as bipolar disorder), schizophrenia, and obsessive-compulsive disorder.  

Using outdated codes 

Each year, the American Medical Association (AMA) releases updates to the Current Procedural Terminology (CPT) code set. For instance, last year Code 96152, a 15-minute behavioral intervention code for a service provided to a patient, was divided into two different codes: 96158 and 96159. 96158 is used for the first 30 minutes of the intervention, and 96159 is used for the next 15 minutes of time spent. Not being aware this can lead to hurdles.

 

Unbundling codes —In mental health billing unbundling is interpreted as an attempt to rasie payment. For instance, this happens when a patient is receiving consecutive intermediate outdoor behavioral health (IOBH) or inpatient treatment program in a residential treatment center (RTC).  Insurance companies are hesitant to pay the daily rate for RTC and IOBH programs as it costs them huge dollars. Therefore, to get reimbursed providers are forced to participate in time intensive appeals process. To avert this providers and billing companies are tempted to “unbundle” RTC or IOBH care. Such temptation to unbundle must be avoided at all costs.

Upcoding — Upcoding is a very common practice in healthcare billing and is usually viewed with suspicion. It is mostly interpreted as an attempt to force the insurer to part with more reimbursement than what is due.  One good example is the time spent with a psychotherapist. Sometimes, a 30 minutes psychotherapy session is passed off as a 60-minute session with the use of code 90837. It is very risky to upcode like this, as in this very instance, the nature of the affliction will reveal if there was a need to have a 60-minute session or not. If it is proven to the contrary then your practice may be penalized

 Secrets to Error Free Mental Health Billing
Make a Claim for Medical Necessity
– Ensure Correct Coding and Modifier Usage
– Bill for Actual Time of Service
– File Claims on Time
Ensure Quality Documentation

Using modifiers incorrectly 

The two-digit code appended to a medical CPT code to provide extra information to the payer about a mental patients’ treatment needs to be executed with great care and understanding. For instance, lets understand about Modifier 25. This Modifier is applied when there is an Evaluation and Management (E/M) service on a day when the same or another physician provided the same patient with another service. As per rules it is not possible to use Modifier 25 when billing for services performed during a postoperative period especially when associated with the previous surgery; if there is only an E/M service performed during the office visit etc.

  Did You Know People with suicidal tendencies have a diagnosable mental disorder – either a substance abuse disorder or a depressive disorder

Documentation errors 

Proper documentation helps to establish to a payer that the services were absolutely necessary. Therefore, great care must be taken while documenting. A few integral aspects of documentation are the reason for the session, the date of the session, relevant history, description of applicable test results, description of assessment, clinical impression and diagnosis.  This must be accompanied with progress notes that should tell in details about the client’s response to treatment and any or rather every change to the diagnosis. A robust documentation makes it easier and faster to get paid.

 

Much of these can be eliminated by following a definite process to coding and billing. Firstly, it’s important to strive for the highest accuracy. The most reliable way is to build a first-class quality control process to cut down on simple to complex coding errors. Keeping the team abreast of most recent CPT changes and making it mandatory to refer to the AMA’s manual are some of the best ways to ensure the use of right codes in your practice.  A fool proof way is to have a dedicated team to meticulously scan through all the notes and included with the codes. Likewise taking the coding through the lens of dedicated modifier specialists can be the difference between maximum and truncated reimbursements.

Who We are and What Makes Us an Expert?

This article is brought to you by OutsourceRCM a pioneer in back-office support services for healthcare providers in the US. One of our areas of specialization is mental health billing services. We have dedicated team of billers and coders to provide coding and billing services for all types of mental disorder treatments. Every bill generated passes through a quality control team who help ensure complete accuracy for timely and complete reimbursements. Contact us now to know more about our services.