Mental health issues are vast and include: anxiety and panic disorders, depression, schizophrenia, personality disorder, narcolepsy, and other sleep disorders. Mental health services provided by licensed psychologists and mental health counselors are reimbursable. Psychiatry medical billing requires accurate coding of the diagnoses and procedures to ensure proper reimbursement. Common documentation issues in reports submitted to Medicare are – missing progress notes, no psychosocial assessment, and failure to establish the necessity of treatment. The more information the record contains about objective findings, patients’ statements, clinical judgments, and your decision making, the better the portrayal of competent care.
According to Medicare, documentation of a psychiatric disability must:
- come from a psychologist, psychiatrist, or family doctor
- be complete and legible
- include relevant medical history, physical examination findings, prior diagnostic test results
- include the patient’s progress, response to changes in treatment, and revision of diagnosis
- include CPT and ICD-10-CM codes supported by documentation in the medical record
For the provider, the key to appropriate insurance reimbursement lies in accurate procedure coding. Coding errors can lead to delayed payments or rejection of submitted claims. Knowing your CPT codes is vital to getting paid in full and avoiding insurance audits.The common CPT codes used to document psychiatric conditions are:
- 90791 – Psychiatric Diagnostic Evaluation (usually just one/client is covered)
- 90792 – Psychiatric Diagnostic Evaluation with medical services (usually just one/client is covered)
- 90832 – Psychotherapy, 30 minutes (16-37 minutes)
- 90834 – Psychotherapy, 45 minutes (38-52 minutes)
- 90847 – Family or couples psychotherapy, with patient present
- 90853 – Group Psychotherapy (not family)
- +90785 – Interactive Complexity add-on code
- +90836 – E/M code for 45 minutes of psychiatry (used with 90834)
DSM 5 and ICD – 10
Unlike other specialists, a psychiatrist’s experience in using DSM-5 substantially simplifies the transition to ICD-10. The Diagnostic and Statistical Manual of Mental Disorders (DSM) Fifth Edition (DSM-5) is the standard classification of mental disorders used by mental health professionals in the United States.
Along with the standard criteria and definitions of mental disorders now approved by the American Psychiatric Association (APA), this latest version of DSM contains both ICD-9 and ICD-10 codes. For instance, diagnosis code for “Separation Anxiety Disorder” in a DSM-5 page is “309.21(F93.0)”. Here, 309.21 is the ICD-9-CM code for this particular disorder, and F93.0 is the ICD-10-CM code. However, certain diagnostic codes sometimes reflect the use of applicable specifiers.
For complex codes, coding notes will be provided at the bottom of the diagnostic criteria box. For example, in Schizoaffective disorder, if catatonia is present, an additional code 293.89 (F06.1) for catatonia should be used. This information will be provided in the coding note.
To save time and money and to eliminate the burden of concentrating on too many aspects of the medical office, psychologists can always choose to outsource their psychiatry coding tasks and thus focus more on patients.
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