Accurately medical billing is not an easy task for a lot of small practices and solo practitioners. The wide range of evolving terms and acronyms used for even the most simple of services can be exceedingly complex. An incorrectly used code or even a simple piece of missing information can lead to significant delays in your revenue stream as well as increasing the risk for a claim rejection or claim denial.
As the various code books continue to evolve physicians and their administrative staff needs to juggle CPT, ICD-10, and DSM 5, just to name a few. Unfortunately, it’s all too easy to select the wrong code. Especially when navigating the sometimes-subjective waters of the mental and behavioral health disciplines.
In this article, we will attempt to demystify some of the more common mental and behavioral health codes to help you understand how to use them better.
What Are CPT Codes?
Current Procedural Terminology or CPT codes are a standardized set of codes that are published, frequently updated, and maintained by the American Medical Association. These are some of the most common codes used in the medical billing industry. Though they certainly are not the only ones used by ABA therapists and other mental healthcare professionals.
In 2013 the CPT codes for psychiatry, psychology, and behavioral health care services a significant revision, and they aren’t scheduled for another update in the foreseeable future. CPT codes are typically used to describe the actions taken, services provided or the treatments administer to clients. They are five-digit codes with broad use throughout the medical industry. Though there are also add-on codes that can also add greater detail to the services provided to a patient.
When it comes to efficient medical billing practices CPT codes are essential for accurate billing and reimbursement from medical insurance providers as well as other payer institutions. Accidentally applying the wrong CPT code can significantly hamper your revenue cycle management in a variety of ways. This includes claim rejections, claim denials, and general delays. Especially if you under code or upcode.
What Is Undercoding & Upcoding?
Under coding
This is when a CPT code is used that represents a lower-priced treatment or a lesser diagnosis. While it can be done accidentally most cases of a physician under coding are usually intentional, as a way to provide their patient with a lower cost for services rendered. Though sometimes under coding occurs to avoid an audit from an insurance company or other payer institution. Unfortunately, under coding is illegal, and may have consequences even if it was done unintentionally.
Upcoding
This is when a physician uses a CPT code that represents a higher-priced treatment or a more significant diagnosis. In many of these cases, upcoding is done intentionally to receive a higher reimbursement rate from the insurance provider or payer institution. While upcoding is unethical and technically illegal it’s not always done with malicious intent. Indeed, some cases of upcoding are simply the result of an untrained staff member entering an incorrect code. Unfortunately, the responsibility for an audit from the insurance company or public payer institution still falls on the physician.
What Are The Most Common CPT Codes Used For Mental Healthcare Professionals?
The good news is of the 800+ CPT codes in the codebook, only 8 tend to be frequently used by psychologists, psychiatrists, and other mental health professionals. They are:
- 90791 – Psychiatric Diagnostic Evaluation
- 90792 – Psychiatric Diagnostic Evaluation with medical services
- 90832 – Psychotherapy, 30 minutes (16-37 minutes)
- 90834 – Psychotherapy, 45 minutes (38-52 minutes)
- 90837 – Psychotherapy, 60 minutes (53 minutes and over)
- 90846 – Family or couples psychotherapy, without the patient present
- 90847 – Family or couples psychotherapy, with the patient present
- 90853 – Group Psychotherapy (not family)
- 90839 – Psychotherapy for a crisis, 60 minutes (30-74 minutes).
Are CPT Codes & ICD-10 Codes Related To DSM Codes?
While you might feel encouraged by the fact that only around 1% of CPT codes are common in the mental healthcare domain, that these codes have important connections to ICD-10 and DSM codes. This means that the physician, therapist, and/or their administrative staff also need to avail themselves of these codes and stay abreast of any changes.
How Are ICD 10 & DSM 5 To CPT Codes?
The first step in understanding the relationship between ICD 10 & DSM 5 and CPT Codes starts with taking a closer look at the relationship between ICD 10 and DSM 5 codes. It’s important to note that both ICD-10 and DSM 5 codes are used for diagnosis, though there are a few key differences.
ICD codes are often used by the World Health Organization (WHO)’s International Classification of Diseases & Related Health Problems. When it comes to billing private insurance companies and public payer institutions they can be used together with CPT codes.
DSM 5 codes are found in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders. This is a taxonomic and diagnostic manual used published by the American Psychiatric Association.
Thankfully ICD-10 and DSM 5 codes are the same. Though the DSM is a guide that helps providers select the correct ICD code. The DSM 5 was technically published in May of 2013 and then was put into effect on the first of January of 2014. This was immediately ahead of when the entire medical community made the full-scale change from using ICD-9 to ICD-10 codes which went into effect on the first of October of 2015.
It’s important to note that DSM is relevant to the mental health community as it specifically endorses and lists most mental and behavioral health ICD codes. Though it can be confusing to know when DSM and ICD codes should be used. This is related to the fact that the DSM 5 is the only accepted guide to ICD codes for mental health providers. It can mistakenly lead some mental health professionals to believe there is a separate list of DSM codes that may or may not be connected with ICD codes. When in all reality there are not.
Ultimately, the relationship between an ICD code and the corresponding CPT code is that the diagnosis needs to support the medical necessity of the associated treatment.
Compounding this, in 2003 HIPPA made it mandatory to have an ICD code included for any electronic transaction that is being used for billing, reimbursement, or reporting. This essentially means that to bill an insurance provider or payer institution you need to have a CPT code included in the documentation that clearly explains the treatment or service you provided to the patient as well as an ICD 10 code that clearly outlines the diagnosis for the patient that leads to the treatment or service rendered.
What Are The Most Common ICD 10 Codes For Mental & Behavioral Health Practitioners?
There are a few ICD 10 codes that you see frequently being used by mental & behavioral health practitioners. This includes the following:
- F32.9 Major depressive disorder, single episode, unspecified
- F32.0 Major depressive disorder, single episode, mild
- F32.1 Major depressive disorder, single episode, mild
- F32.1 Major depressive disorder, single episode, moderate
- F32.2 Major depressive disorder, single episode, severe without psychotic features
- F32.3 Major depressive disorder, single episode, severe with psychotic features
- F32.4 Major depressive disorder, single episode, in partial remission
- F32.5 Major depressive disorder, single episode, in full remission
- F32.8 Other depressive episodes
- F33.1 Major depressive disorder, recurrent, moderate
- F33.2 Major depressive disorder, recurrent severe without psychotic features
- F33.3 Major depressive disorder, recurrent, severe with psychotic symptoms
- F39 Unspecified mood [affective] disorder
- F25.9 Schizoaffective disorder, unspecified; See also:
- F25.0 Schizoaffective disorder, bipolar type,
- F25.1 Schizoaffective disorder, depressive type,
- F25.8 Other schizoaffective disorders
- F29 Unspecified psychosis not due to a substance or known physiological condition
- F41.9 Anxiety disorder, unspecified
- F41.1 Generalized anxiety disorder
- F41.8 Other specified anxiety disorders
- F41.0 Panic disorder [episodic paroxysmal anxiety] without agoraphobia
- F41.1 Generalized anxiety disorder
- F42 Obsessive-compulsive disorder
- F32.1 Agoraphobia with panic disorder
- F90.0 Attention-deficit hyperactivity disorder, predominantly inattentive type
- F90.1 Attention-deficit hyperactivity disorder, predominantly hyperactive type
- F90.2 Attention-deficit hyperactivity disorder, combined type
- F90.8 Attention-deficit hyperactivity disorder, another type
- F90.9 Attention-deficit hyperactivity disorder, unspecified type
- G30.0 Alzheimer’s disease with early-onset
- G30.1 Alzheimer’s disease with late-onset
- G30.8 Other Alzheimer’s disease
- G30.9 Alzheimer’s disease, unspecified
- F31.9 Bipolar disorder, unspecified
- F31.0 Bipolar disorder, current episode hypomanic
- F31.10 Bipolar disorder, current episode manic without psychotic features, unspecified
- F31.11 Bipolar disorder, current episode manic without psychotic features, mild
- F31.12 Bipolar disorder, current episode manic without psychotic features, moderate
- F31.13 Bipolar disorder, current episode manic without psychotic features, severe
- F31.30 Bipolar disorder, current episode depressed, mild or moderate severity, unspecified
- F31.31 Bipolar disorder, current episode depressed, mild
- F11.20 Opioid dependence, uncomplicated
- F11.21 Opioid type dependence in remission
- F11.220 Opioid dependence with intoxication, uncomplicated
- F11.221 Opioid dependence with intoxication delirium
- F11.22 Opioid dependence with intoxication with perceptual disturbance
- F43.10 Posttraumatic stress disorder, unspecified
- F43.11 Posttraumatic stress disorder, acute
- F43.12 Posttraumatic stress disorder, chronic
- F43.23 Adjustment disorder with mixed anxiety and depressed mood
- Z79.891 Long term (current) use of opiate analgesic
- Z79.899 Other long terms (current) drug therapy
- Z03.89 Encounter for observation for other suspected diseases and conditions ruled out
It’s important to note that there are only some of the more common ICD 10 codes used by mental health professionals. There might be other conditions that required different codes. So, it’s important to stay up to date on ICD 10 codes and related CPT codes for mental health.
Benefits Of Outsourcing Your Medical Billing & Coding
If you are a solo practitioner or you have a small mental health practice, you might want to consider outsourcing your medical coding & billing to a third-party service like Operant Billing Solutions. You can trust that our experienced professionals have the special skills, meticulous attention to detail, and years of training to ensure that all your claims are correctly coded before being sent to the payer institution.
Not only does this reduce the risk of delayed, denied, or rejected claims in your revenue stream, but it also frees up your time to focus on serving your patient’s needs. In time this could even lead to expanding the size or scope of your mental health practice.
