Errors in medical billing codes tend to be one of the most common reasons that a claim is denied or rejected by mental and behavioral health payers. Not only can this lead to massive delays and inconsistencies in your practice’s revenue stream, but it can cause other long-term complications.
A solo practitioner or a small practice that has frequent medical coding errors can sometimes draw a red flag from a private insurance company, public health institution, or another type of payer organization. These red flags can sometimes lead to audits that waste your practice’s valuable time. In some cases, it can even draw penalties or alterations in your practice’s reimbursement rate from that payer institution.
Of course, the overall memorization requirements and correct application of CPT codes can be immense. Especially for providers who don’t have an in-house administrative staff or a third-party medical billing agency to handle their coding needs. This is part of what makes insurance billing so complicated for solo practitioners and small practices.
Being able to use every CPT code in the correct context will factor into a provider’s ability to produce clean claims. This in turn leads to a more consistent revenue cycle. Yet with so many different CPT codes, it can be difficult to know exactly when to apply each one for each instance and case.
There are a lot of potential consequences that come with incorrect coding that goes beyond simply forfeiting reimbursements. It’s a well-known fact that insurance companies and public health institutions are always on the lookout for potential fraud. Over the years it has made them prone to seeking out any opportunity to deny a provider’s claim for reimbursement.
The term “Clean Claim” is for medical billing claims that are approved with the first submission. Clean claims are the ideal scenario for any provider or small practice working with insurance. It essentially means they will be reimbursed in a timely manner thanks to their diligent insurance billing practices.
Of course, the foundation of a truly clean claim is the CPT codes used to generate their claim. Accuracy in this area is a major factor in getting the claim paid promptly, avoiding costly audits, as well as maximizing your potential for negotiating higher reimbursement rates from a payer institution in the future.
Current Procedural Terminology (CPT) is used to reflect a wide range of factors. This includes:
- Diagnostic Testing
- Ancillary Services Provided
CPT codes are used for a wide range of patients in many disciplines. This included medical, surgical, general healthcare, imaging diagnostics, mental healthcare, and a wide range of behavioral health fields.
Fortunately, there are several different ways that solo practitioners, small practices, and specialist providers can refine their coding and claims process to optimize their clean claims. Especially for mental health providers who frequently need to use CPT code 99284. Knowing precisely when and how to use it, as well as what tools you can use it for, will go a long way toward increasing the number of clean claims your practice has approved.
What Is CPT Code 99284 & How To Use It?
CPT code 99284 is just one part of a set of codes that are often used to describe emergency department visits. This includes the evaluation and management of a specific patient.
CPT code 99284 is defined in the official CPT code book manual as being for “Emergency department visit for the evaluation and management of a patient, which requires these 3 key components.”
- Component 1: Must include a detailed history
- Component 2: Requires a detailed examination
- Component 3: Clearly delineated medical decision-making of a moderate complexity
A lot of times counseling and coordination of care with other physicians, qualified health care professionals, diagnosticians, specialist providers, or agencies happen with consistency. Most of the time, the presenting problem is of high severity, which then requires urgent evaluation by the physician or some other type of qualified health care professional. Even if it doesn’t pose an immediate or significant threat to life or the individual’s physiologic function.
Many critical details need to be included any time you use CPT Code 99284. This includes the history collected, the detail in the examination, and the level or the complexity of the decision-making process.
Common Codes Used in Conjunction with CPT Code 99284
Of course, CPT code 99284 is rarely standalone in most emergency situations. It often occurs with other codes, and the details linking these codes with the prevailing condition also need to be accurate to generate a truly clean claim that will get approved with the first submission.
CPT Code 99281
CPT Code 99281 is one of the more common codes used in conjunction with Code 99284. It can be used to denote several things such as:
- Problem Focused History
- Problem Focused Examination
- Straightforward Medical Decision Making
- Presenting Problem Is Usually Minor
CPT Code 99282
CPT Code 99282 is another common code used with clean claims involving Code 99284. It must include:
- Expanded Problem-Focused History
- Expanded Problem-Focused Examination
- Medical Decision-Making of Low Complexity
- Problem is Usually Low Severity
CPT Code 99283
With CPT Code 99283, the severity of the problem is typically higher. This code includes:
- Expanded Problem-Focused History
- Expanded Problem-Focused Examination
- Medical Decision Making of Moderate Complexity
- Problem is Usually Moderate Severity
CPT Code 99285
CPT Code 99285 is also used for emergency department visits for the evaluation and management of a patient. It also requires 3 key components to generate a clean claim. Though there are specific constraints imposed by the urgency of the patient’s clinical condition or their current mental status. It requires the provider to include:
- A Comprehensive History
- A Comprehensive Examination
- The Medical Decision Making of High Complexity
The Problem Also Needs To Be Usually of High Severity/Poses an Immediate/Significant Threat to Life or Physiologic Function
Ways to Improve Mental Health Coding & Billing Practices
A lot of mental health care providers and ABA specialists only receive a minimal level of training in medical coding and billing practices. This only makes sense as their focus rightly should be on treating their patients. Fortunately, there are a few things you can do to ensure that you are using CPT Code 99284 and other important medical billing codes correctly.
This includes things like using up-to-date medical coding & billing software. Hiring an in-house administrative staff to specialize in medical coding, billing, and claims management.
Though a lot of small practices and solo practitioners find that outsourcing their medical coding and billing practices to a third-party agency like Operant Billing Solutions is the ideal way to ensure that all CPT codes are correctly entered when submitting a clean claim.
You can trust our experts to turn a keen eye toward making sure all aspects of your claim are coded and submitted correctly. This frees you and any in-house staff you have to focus on providing the highest level of care to your patients, as well as giving you more time to explore ways to expand your practice in the long term.