Stop leaving dollars on the table for mental health services for intake and time. You can add hundreds in revenue using psychotherapy CPT coding tips. Implement these expert tactics to up your reimbursement without attracting unwanted audit attention.
Bill New Intake Session after Patient Absence (Codes 90701, 90792)
Because many plans pay more for CPT® codes 90791 (psychiatric diagnostic evaluation) and 90792 (psychiatric diagnostic evaluation with medical services) than regular sessions, they’ll only allow you to bill one intake session per client. However, there are instances where an additional intake session is warranted:
- Different days: Some payers will reimburse for two intake sessions per patient if you must conduct a separate diagnostic session with an informant, as long as they occur on different days. For example, say you conducted an intake session with a child. Then, you conduct a separate intake session with the parent. Don’t be afraid to bill for both.
- Extended absence: If you’re seeing a current patient after a significant absence, consider billing for an additional intake session. What’s a significant absence? If a patient skips two sessions because they are on vacation, a new intake session won’t fly with payers. But if a client has been gone for months, you may legitimately need to reassess what’s going on in their lives. It depends on the payer, but some will allow you to bill no more than 2-3 intake sessions per year. Be sure that your documentation includes evidence that the new intake was really necessary.
Fraud Alert! Some clinicians erroneously believe that you can bill a current patient for a new intake session if their insurance carrier has changed. You may not.
Be Sure You’re Billing for All of Your Time
When billing psychotherapy sessions, be sure you count only the time between when the session begins and when it ends. You may not include time used for paperwork, waiting for a late patient, or other tasks that aren’t part of the actual psychotherapy. Be sure to record start and stop times for every client for every session in the patient record. If a payer audits your records, they will check to ensure that the time you’re billing matches the time recorded in your documentation.
Some insurers pay more for 90837 (individual psychotherapy, 60 minutes) than they do for 90834 (individual psychotherapy, 45 minutes). If you typically conduct a 50 minute session, you could start billing with 90827 by simply extending the length of your session by three minutes—the threshold to bill 90837 is 53 minutes.
Tip: Even if you’re an out-of-network provider whose patients submit their own claims, it pays to be familiar with the payers. Before billing 90837, ask your patient who their insurer is. Some payers require prior authorizations for 90837. If you don’t have one, the claim will be rejected and you’re patient won’t be happy. If a payer requires a prior authorization to bill 90837, and you don’t have one, stick with 90834. Typically, insurance plans won’t reimburse more than one of the same service for the same patient on the same day, so simply billing two shorter sessions isn’t an option. But that doesn’t mean you can’t get paid for extended sessions. Try these tips:
- Use prolonged service add-on codes. Codes 99354 (prolonged service with direct patient contact, first hour) and 99355 (prolonged service with direct patient contact, each additional 30 minutes beyond the first hour) used to be reserved for physicians and medical staff to add on to E/M codes. But now, non-medical providers can attach it to code 90837. You may bill one unit per date of service for 99354, and four units for 99355. However, you can only use these add-on codes for individual sessions—not couples or group session.
- If you are conducting a crisis session, use codes 90839 (psychotherapy for crisis; first 60 minutes) and 90840 (psychotherapy for crisis; each additional 30 minutes). Be sure that your session meets the definition for crisis billing, and remember: whether or not that definition is met is based your assessment of the situation—not the patient’s. Be certain that crisis billing is supported in the patient record.
Warning! You are responsible for what is billed even though you don’t code your claims. If your mental health claims are incorrectly coded, you can be targeted for an audit.
Then, auditors can dig through your records for years to identify violations and apply hefty penalties and fines across the board. Ensuring your claims are coded and reimbursed correctly doesn’t have to be hard, if you know how…
That’s where expert author and therapist, Barbara Griswold, LMFT can help. During her online training session Psychotherapy Coding Tips: Maximize Reimbursement, Prevent Denials, you can boost your understanding of mental health CPT coding to ensure your claims are billed correctly, that you get paid more of what you deserve, and stay under auditor radars.
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