Knowing when and how to correctly apply a CPT code is one of the most challenging aspects of mental health insurance billing. It typically requires the memorization and correct application of a staggering array of CPT codes.
For a lot of solo practitioners, small practices, and ABA therapists, knowing exactly when to use a specific CPT code and in what situation can feel daunting. Yet accuracy is exactly how providers secure prompt payment from a “Clean Claim” that is approved by a payer or public health institution on the very first submission.
Yet, with such a staggering array of different CPT codes, it can be difficult to know exactly when to apply each one. Even the slightest of errors can lead to denied claims, requests for resubmission, and outright claim rejections. All of these things can severely impact a practice’s revenue cycle. Not to mention putting your small practice at risk of an audit from one or more payer institutions.
Any time a claim is coded incorrectly, the provider risks forfeiting their time and possibly their reimbursement rate. The only hope is to quickly correct and resubmit that claim in hopes it will be approved the second time. Though recurring errors and resubmissions can also trigger a costly audit from an insurance company or even a public health institution.
When it comes to medical billing the goal of any mental health provider is to improve their claims process to maximize the number of clean claims. This effectively increases the number of approved claims that get approved after their very first submission. It also translates into a more robust and consistent revenue stream.
How Are CPT Codes Used?
Current Procedural Terminology, more commonly known as CPT codes is used to reflect testing, procedures, evaluations, and other necessary services that are provided to a patient of a client. CPT codes are used in the healthcare industry, mental health arena, and behavioral health fields.
CPT code 99202 is a very common code used by a wide range of mental health providers. Though knowing exactly what it is, and when to use it can be a little complicated. Especially for solo practitioners and small practices who don’t have extensive training in coding and medical billing or don’t have administrative staff who are trained in medical billing best practices.
What Is CPT Code 99202 & How Is It Used?
CPT Code 99202 is technically just one part of a larger set of codes that are often used to describe E/M New Patient Office Visits. It’s worth noting that Code 99202 is specifically limited to an E/M New Patient Office Visit that lasts between 11 to 20 minutes. The official definition of CPT code 99202 according to the CPT code book notes that it is to be used for:
Office or other outpatient visits for the evaluation and management of a new patient. This specifically requires 3 components:
- Component 1: An expanded problem-focused history
- Component 2: An expanded problem-focused examination
- Component 3: Straightforward medical decision making
Counseling and any coordination of care with other providers, healthcare specialists, or third-party agencies must be provided consistent with the nature of the patient’s problem and/or family’s needs. Typically, the presenting problem or problems are of low to moderate severity.
Other Codes Used With or to Replace CPT Code 99202
Several other CPT codes can appear in conjunction with code 99202. Some provide additional information, and some are simply modifiers or methods for better describing the severity or type of services rendered.
There are also replacement codes that a provider might use to note a different length of session or treatment services rendered.
CPT Code 99201
This is used for E/M New Patient Office Visit Lasting 10 Minutes or less. If a session were to last for 11 to 20 minutes then CPT Code 99202 should be used when submitting the claim.
CPT Code 99203
This is for E/M New Patient Office Visit Lasting up to 30 Minutes. This is one of the more common replacement codes for 99202.
CPT Code 99204
This is for E/M New Patient Office Visit Lasting between 31 to 45 Minutes. It is significantly longer than CPT code 99202 and might influence the reimbursement rate from the payer or public health institution.
CPT Code 99205
This code is for E/M New Patient Office Visit Lasting between 46 to 60 Minutes.
When to Use CPT Code 99202
For mental healthcare providers who offer E/M new patient services, the degree of decision-making will largely affect when you should use CPT code 99202. At higher levels of clinical decision-making, you might need to use a different code to note a longer or shorter session.
The American Psychiatric Association, further notes that “When billing outpatient E/M on the basis of time, psychiatrists can use the total time on the date of the service related to the patient encounter, not just the face-to-face time.”
This specifically includes the following:
- Preparing to see a new patient
- Review of test for a new patient
- Reviewing a new patient’s records
- Obtaining or reviewing a separately obtained history
- Performing a medically necessary exam and/or evaluation
- Counseling and educating the patient/family/caregiver
- Ordering medications
- Ordering tests & diagnostics that are deemed necessary for treatment
- Ordering procedures
- Referring and communicating with other healthcare professionals
- Documenting clinical information in the electronic or paper health record
- Independently interpreting results of tests/labs and communicating results to the family or caregiver
- Care coordination
Ways To Improve Your Coding Process
There are a few different ways to improve your coding practices. Though the two most effective way to improve the accurate use of CPT code 99202 is to use electronic mental health billing software or to outsource your medical billing to a third-party agency.
The right software will go a long way toward helping you navigate the coding process. This will also increase the percentage of clean claims paid to your practice, which will boost your incoming revenue, as well as provide you with a more consistent revenue stream.
State-of-the-art medical billing software helps in a variety of ways. This includes the ability to do things like:
- Electronically bill primary insurance
- Electronically bill secondary insurances
- Billing providers who are considered to be out-of-network by the patient’s coverage
- Quickly check claim status
- Track client and insurance payments
- Track Insurance Authorizations
When you outsource your claim submission process to a third-party vendor like Operant Billing Solutions, you can trust that medical billing experts are bringing years of training, and experience to ensure that all your codes are correctly entered. This dramatically boosts the number of clean claims your practice produces, giving you a more consistent revenue stream.
Best of all, it reduces the time you or your administrative staff need to spend dealing with claim submissions. It also drastically reduces the kind of claim denials, rejections, and requests for resubmission that can trigger an audit from a payer or public health institution.