There are two changes in the psychiatry section of CPT for 2017 behavioral health billing. The first is the description of psychotherapy CPT codes were revised to remove the words “and/or family.” In 2016, CPT code 90832 was defined as “Psychotherapy, 30 minutes with patient and/or family member.” In 2017 the definition is “Psychotherapy, 30 minutes with patient.” Codes 90833, 90834, 90836, 90837, 90838, and 90839 were similarly revised.

Codes 90832, 90833, 90834, 90836, 90837, 90838 describe psychotherapy for the individual patient, although times are for face to face services with patient and may include informant(s). The patient must be present for all or a majority of the service.

Family psychotherapy now has time added to the description.

CPT code 90846 was revised from “Family psychotherapy (without the patient present),” to “Family psychotherapy (without the patient present), 50 minutes.”

CPT code 90847 was revised from “Family psychotherapy (conjoint therapy) (with the patient present),” to “Family psychotherapy (conjoint therapy) (with the patient present), 50 minutes.”

Psychotherapy codes follow the CPT time rule, which is that in order to bill the service; the clinician must meet the mid point of time. In this case, in order to bill either 90846 or 90847, the family therapy must be at least 26 minutes. As always, document time in the medical record when time is a descriptor.

CPT is making a clearer distinction between Individual and Family therapy.

Individual psychotherapy (codes 90832, 90834, 90837) may involve informants (i.e., family members, caregivers).

• A code’s stated time (e.g., 30 minutes) is relevant only for face-to-face time with the patient. No additional time is reported for time with the informant.
• Therapy using family psychotherapy techniques should be reported with either 90846 (without patient present) or 90847 (with patient present). 90846 and 90847 should not be reported for family therapy sessions shorter than 26 minutes.
• The patient must be present for all or a majority of the service.
• Do not report psychotherapy codes for sessions shorter than 16 minutes.
• Codes 90832, 90833, 90834, 90836, 90837, 90838 can be reported on the same-day as codes 90846 and 90847, provided that the services are separate and distinct. Be sure to include modifier 59 to emphasize that the services are separate and distinct.

In this blog we will break down each area and show you how to improve your revenue cycle management for your substance abuse and/or mental health treatment center. 1. Verification of Benefits: There are many downfalls with the verification of benefits process. Inaccurate benefit quotes, unknown information that is not provided by the insurance carrier, knowing paid amounts of each insurance carrier/policy etc.

One way to ensure you are receiving accurate benefits is to utilize verification of benefit experts who know and understand the many nuances of each insurance carrier. Having the ability to ensure you are getting a comprehensive verification of benefits quotes can make or break your behavioral health billing organization.

2. Claim Management: Managing claims can be one of the most times consuming tasks associated with behavioral health insurance billing and management. Claims often seem to fall by the way side if diligent management processes are not being enforced.

Your processes should include a plan of action for each scenario that can occur with a claim being processes. What if the claim is denied? What if the claim is taking longer than average to process? You must have policies and procedures surrounding these issues.

Another aspect of the claims management process is the frequency in which you are contacting the insurance company to find out where claims are. Many billing organizations or departments have a passive approach to managing claims.  Having an active process to managing claims reduces ageing claims, increases cash flow and speeds up denials management.

3. Authorization and Utilization Reviews: One of the key aspects of pre-authorizations and utilization reviews is having well rounded masters level clinicians trained specifically in these processes. Clinicians are not trained in their masters program to manage insurance in any shape way or form. Unfortunately, this puts the majority of clinicians at a disadvantage for obtaining adequate authorizations for patients.

In order to assist with ensuring competency in your clinician you must have a specialized training program in place that will educate them on how to affectively obtain authorizations as well as continued stay reviews.

4. Denials and Appeals: Whether you are dealing with an authorization denial or a claim denial having a granular approach to denials management yields the best results. Look at the different denial reasons that are common in behavioral health billing and create a course of action for each type of denial. The course of action leads directly into the appeals process.

There are a variety of appeal methods that can be utilized when managing authorization or claim denials. Familiarising your team with the many appeal options is crucial to overturning denials.

Detailed documentation is also a vital piece in this process. Be sure to create comprehensive notes and save a copy of all insurance correspondence between your organization and the insurance carriers.

5. Claim Reconciliation and Accounting: Many programs and billing organizations do not consider the importance of diligent accounting. Not only must you accurately input the payment details you must also compare the payment to the benefits plan to ensure claim payment was made accurately.

Your billing organisation must have multiple quality control matrices and safeguards put in place to confirm accuracy.

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