Coding and Payment Guide for Behavioral Health Services

Transcription

1 Coding and Payment Guide for Behavioral Health Services [80104] Drug screen, qualitative; multiple drug classes chromatographic method, each procedure single drug class method (eg, immunoassay, enzyme assay), each drug class multiple drug classes other than chromatographic method, each procedure This test may be requested as a drug screen for multiple drug classes. The screening test must be performed by a chromatographic technique that has good sensitivity, although it may not be as specific as a confirmatory test. Thin-layer chromatography is a common chromatographic technique for drug screening tests. It is performed by applying a thin layer adsorbent to a rectangular plate in the stationary phase. The specimen is applied to the plate and the end of the plate is placed in a solvent. As the solvent rises along the adsorbent on the plate, the different components of the specimen are carried along at varying rates and deposited along the plate. The different components can be separately visualized and analyzed. Positive tests are always confirmed with a second method. Specimen type varies. Code is a resequenced code and will not display in numeric order. Refer to codes in the Chemistry section ( ) or the Therapeutic Drug Assay section of the CPT book for quantitation of drugs screened ( ). To report the professional services for drug management, see HCPCS Level II code M0064, CPT code 90683, the appropriate level of E/M service, or the appropriate psychotherapy with E/M service code. Follow third-party payer guidelines when selecting the appropriate code for these services. If a specimen is transported to an outside laboratory, report for handling or conveyance. These codes represent a CLIA-waived test Opioid type dependence, unspecified Opioid type dependence, continuous Opioid type dependence, episodic Sedative, hypnotic or anxiolytic dependence, unspecified Sedative, hypnotic or anxiolytic dependence, continuous Sedative, hypnotic or anxiolytic dependence, episodic Cocaine dependence, unspecified Cocaine dependence, continuous Cocaine dependence, episodic Cannabis dependence, unspecified Cannabis dependence, continuous Cannabis dependence, episodic Amphetamine and other psychostimulant dependence, unspecified Amphetamine and other psychostimulant dependence, continuous Amphetamine and other psychostimulant dependence, episodic Hallucinogen dependence, continuous Hallucinogen dependence, episodic Other specified drug dependence, continuous Other specified drug dependence, episodic Combinations of opioid type drug with any other drug dependence, continuous Combinations of opioid type drug with any other drug dependence, episodic Combinations of drug dependence excluding opioid type drug, continuous Combinations of drug dependence excluding opioid type drug, episodic Nondependent cannabis abuse, continuous Nondependent cannabis abuse, episodic Nondependent hallucinogen abuse, continuous Nondependent hallucinogen abuse, episodic Nondependent sedative hypnotic or anxiolytic abuse, continuous Nondependent sedative, hypnotic or anxiolytic abuse, episodic Nondependent opioid abuse, continuous Nondependent opioid abuse, episodic Nondependent cocaine abuse, continuous Nondependent cocaine abuse, episodic Nondependent amphetamine or related acting sympathomimetic abuse, continuous Nondependent amphetamine or related acting sympathomimetic abuse, episodic Nondependent antidepressant type abuse, continuous Nondependent antidepressant type abuse, episodic IOM References 100-4,16, Also not with 80100: 80101, , G0431v Also not with 80101: , G0431v Procedure Codes Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Non- Non

2 Procedure Codes Drug confirmation, each procedure This test may be requested as drug screen confirmation. It is performed when the initial drug screen ( ) is positive. Confirmatory tests must be both sensitive and specific and involve a different technique than the initial screen. For example, if the initial screen is performed by thin layer chromatography identifying a spot on the chromatogram that is the right color and in the right place to be consistent with a particular drug, it is confirmed with a more specific method, like high performance liquid chromatography (HPLC), gas chromatography-mass spectrometry (GC-MS), or immunoassay. If the drug suspected is a barbiturate, for example, a confirmatory HPLC method might be done to prove that the compound had the correct retention time, etc., and to identify it exactly as a particular barbiturate. Refer to codes in the Chemistry section ( ) or the Therapeutic Drug Assay section of the CPT book for quantitation of drugs screened ( ). Report for each procedure necessary for confirmation. To report the professional services for drug management, see HCPCS Level II code M0064, CPT code 90863, the appropriate level of E/M service, or the appropriate psychotherapy with E/M service code. Follow third-party payer guidelines when selecting the appropriate code for these services. If a specimen is transported to an outside laboratory, report for handling or conveyance Opioid type dependence, unspecified Opioid type dependence, continuous Opioid type dependence, episodic Sedative, hypnotic or anxiolytic dependence, unspecified Sedative, hypnotic or anxiolytic dependence, continuous Sedative, hypnotic or anxiolytic dependence, episodic Cocaine dependence, unspecified Cocaine dependence, continuous Cocaine dependence, episodic Cannabis dependence, unspecified Cannabis dependence, continuous Cannabis dependence, episodic Amphetamine and other psychostimulant dependence, unspecified Amphetamine and other psychostimulant dependence, continuous Amphetamine and other psychostimulant dependence, episodic Hallucinogen dependence, unspecified Hallucinogen dependence, continuous Hallucinogen dependence, episodic Combinations of opioid type drug with any other drug dependence, unspecified Combinations of opioid type drug with any other drug dependence, continuous Combinations of opioid type drug with any other drug dependence, episodic Combinations of drug dependence excluding opioid type drug, unspecified Combinations of drug dependence excluding opioid type drug, continuous Nondependent cannabis abuse, continuous Nondependent cannabis abuse, episodic Nondependent hallucinogen abuse, continuous Nondependent hallucinogen abuse, episodic Nondependent sedative hypnotic or anxiolytic abuse, continuous Nondependent sedative, hypnotic or anxiolytic abuse, episodic Nondependent opioid abuse, continuous Nondependent opioid abuse, episodic Nondependent cocaine abuse, continuous Nondependent cocaine abuse, episodic Nondependent amphetamine or related acting sympathomimetic abuse, continuous Nondependent amphetamine or related acting sympathomimetic abuse, episodic Nondependent antidepressant type abuse, continuous Nondependent antidepressant type abuse, episodic Coding and Payment Guide for Behavioral Health Services Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Non- Non

3 Coding and Payment Guide for Behavioral Health Services Tissue preparation for drug analysis Procedure Codes Tissue is sometimes tested for the presence of drugs. This code reports the tissue preparation only. If a specimen is transported to an outside laboratory, report for handling or conveyance. CPT codes are used to indicate the qualitative screening of drugs or classes of drugs. Those drugs commonly assayed include alcohols, amphetamines, barbiturates, benzodiazepines, cocaine and metabolites, methadones, methaqualones, opiates, phencylidines, propoxyphenes, phenothiazines, propoxyphenes, tetrahydrocannabinoids, and tricyclic antidepressants. tissue. Group of similar cells with a similar function that form definite structures and organs. Tissue types include epithelial tissue, muscle tissue, connective tissue, and nervous tissue. V70.4 Examination for medicolegal reason (Use additional code(s) to identify any special screening examination(s) performed: V73.0-V82.9) Non- Non

4 Procedure Codes Amitriptyline Amitriptyline is a tricyclic antidepressant and the prototype brand name is Elavil. Test specimens are frequently collected at the trough period, which is about 12 hours after the last dose when serum concentration is at its lowest. This is an effective approach to determine a therapeutic level of drug. Drug overdose may be reason for the test as well. Method is typically high performance liquid chromatography (HPLC) or gas liquid chromatography (GLC). This drug may be prescribed for disorders outside of depressive states, such as chronic pain. This examination is quantitative. For nonquantitative testing, see To report the professional services for drug management, see HCPCS Level II code M0064, CPT code 90863, the appropriate level of E/M service, or the appropriate psychotherapy with E/M service code. Follow third-party payer guidelines when selecting the appropriate code for these services. If a specimen is transported to an outside laboratory, report for handling or conveyance. Episodic mood disorders (classified to category 296 in ICD-9-CM) are recurrent, severe disturbances of mood accompanied by one or more of the following: delusions, perplexity, disturbed attitude to self, or disorder of perception and behavior. While subcategories identify the type (e.g., manic or major depressive, bipolar, etc.) and episodic nature (e.g., single, recurrent, etc.) of the disorder, the fifth-digit assignment identifies severity of the episode. Amitriptyline may also be used in the treatment of pain. ICD-9-CM category 338 Pain, not elsewhere classified, provides subclassification codes that enable reporting of specific underlying causes of pain, as well as its acuity or chronicity. Category 338 contains an instructional note to coders to use an additional code (307.89) to identify pain associated with psychological factors. It also contains an exclusions note for generalized and localized pain, as well as pain disorder exclusively attributed to psychological factors Major depressive disorder, single episode, mild (Use Major depressive disorder, single episode, moderate (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Major depressive disorder, single episode, severe, without mention of psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition Major depressive disorder, single episode, severe, specified as with psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition Major depressive disorder, recurrent episode, mild (Use Major depressive disorder, recurrent episode, moderate (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Major depressive disorder, recurrent episode, severe, without mention of psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to ) Major depressive disorder, recurrent episode, severe, specified as with psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to ) Bipolar I disorder, most recent episode (or current) depressed, mild (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Bipolar I disorder, most recent episode (or current) depressed, moderate (Use additional code to identify any associated physical disease, injury, or condition Bipolar I disorder, most recent episode (or current) depressed, severe, without mention of psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Bipolar I disorder, most recent episode (or current) depressed, severe, specified as with psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Poisoning by tricyclic antidepressants Coding and Payment Guide for Behavioral Health Services Non- Non

5 Coding and Payment Guide for Behavioral Health Services Benzodiazepines Benzodiazepines encompass a family of mild sedatives, including diazepam (Valium) and Ativan. These drugs may be assayed to determine therapeutic levels, or sometimes to determine levels in the system following overdose. Test specimens are frequently collected at the trough period, which is about 12 hours after the last dose when serum concentration is at its lowest. Method is high performance liquid chromatography (HPLC), gas liquid chromatography (GLC), or radioimmunoassay (RIA). This family of drugs may be prescribed for numerous conditions and disorders. Alcohol withdrawal is a common use for diazepam, as are muscle spasms. Each assay is separately reportable. This code reports quantitative therapeutic drug assay from any source. For qualitative testing, see CPT codes Test assays are frequently collected at peak and trough periods (i.e., shortly after administration of the drug and approximately 12 hours after drug administration). If a specimen is transported to an outside laboratory, report code for handling or conveyance Delirium due to conditions classified elsewhere (Code first the associated physical or neurological condition) Subacute delirium (Code first the associated physical or neurological condition) Psychotic disorder with delusions in conditions classified elsewhere (Code first the associated physical or neurological condition) Psychotic disorder with hallucinations in conditions classified elsewhere (Code first the associated physical or neurological condition) Mood disorder in conditions classified elsewhere (Code first the associated physical or neurological condition) Anxiety disorder in conditions classified elsewhere (Code first the associated physical or neurological condition) Procedure Codes Alcohol withdrawal delirium Alcohol-induced persisting amnestic disorder Alcohol-induced persisting dementia Alcohol-induced psychotic disorder with hallucinations Idiosyncratic alcohol intoxication Alcohol-induced psychotic disorder with delusions Alcohol withdrawal Other specified alcohol-induced mental disorders Drug withdrawal (Use additional code for any associated drug dependence: Use additional E code to identify drug) Drug-induced psychotic disorder with delusions (Use additional code for any associated drug dependence: Use additional E code to identify drug) Drug-induced psychotic disorder with hallucinations (Use additional code for any associated drug dependence: Use additional E code to identify drug) Pathological drug intoxication (Use additional code for any associated drug dependence: Use additional E code to identify drug) Drug-induced delirium (Use additional code for any associated drug dependence: Use additional E code to identify drug) Other specified drug-induced mental disorder (Use additional code for any associated drug dependence: Use additional E code to identify drug) Non- Non

6 Procedure Codes Caffeine Coding and Payment Guide for Behavioral Health Services Caffeine is the most widely consumed stimulant in the world and is found in beverages, foods, and medications. This drug may cause moderate to severe symptoms and/or caffeine toxicity. Blood specimen is collected via venipuncture. Test specimens are collected randomly rather than at trough level. A quantitative analysis of caffeine in the bloodstream does not influence medical management of the patient. This test is most commonly used on neonatal patients that are not responding to caffeine therapy or have suspected toxicity of caffeine. Method is enzyme immunoassay (EIA). This code is new for This test is quantitative. For nonquantitative testing, see If specimen is transported to an outside laboratory, report for handling or conveyance E854.2 E980.3 V72.60 Drug induced sleep disorders (Use additional code for any associated drug dependence: Use additional E code to identify drug) Unspecified tachycardia Palpitations Chest pain, unspecified Poisoning by caffeine Accidental poisoning by psychostimulants Poisoning by tranquilizers and other psychotropic agents, undetermined whether accidentally or purposely inflicted Laboratory examination, unspecified Non- Non

7 Coding and Payment Guide for Behavioral Health Services Carbamazepine; total This drug, also known as Tegretol, is an enzyme inducer. Blood specimen collection is by venipuncture. CSF is obtained by spinal puncture, which is reported separately. Test specimens for total levels (80156) are frequently collected at the trough period, which is about 12 hours after the last dose when serum concentration is at its lowest. This is an effective approach to determine a therapeutic level of drug. Test specimens for free drug concentrations (80157) may be collected near peak levels about two to eight hours after ingestion. Methods include high performance liquid chromatography (HPLC) or gas liquid chromatography (GLC) for both types of analysis. This drug is absorbed slowly and erratically by the GI tract and a total concentration may be required, depending on the treatment underway. Methods include high performance liquid chromatography (HPLC) or gas liquid chromatography (GLC). Tegretol may be administered for such conditions as trigeminal neuralgia, epilepsy, and manic disorders. It is known for its anticonvulsant and pain management properties. This examination is quantitative. See for nonquantitative testing. To report the professional services for drug management, see HCPCS Level II code M0064, CPT code 90863, the appropriate level of E/M service, or the appropriate psychotherapy with E/M service code. Follow third-party payer guidelines when selecting the appropriate code for these services. If a specimen is transported to an outside laboratory, report for handling or conveyance. Episodic mood disorders (classified to category 296 in ICD-9-CM) are recurrent, severe disturbances of mood accompanied by one or more of the following: delusions, perplexity, disturbed attitude to self, or disorder of perception and behavior. When coding a bipolar disorder, correct code assignment is dependent upon the patient's mood. Assign a fourth digit of 0 or 4 when the documentation indicates that the patient is in the manic phase; characterized by hyperactivity, extreme agitation or exaggerated excitability, and/or accelerated speech and thought processes. A fourth digit of 5 should be assigned when the patient is in the depressive phase. Medical record documentation may indicate that the patient is exhibiting sadness, low self-esteem, feelings of guilt, interrupted sleep, or withdrawal from family and/or friends. A bipolar disorder may also be mixed and documentation indicates that the patient exhibits mood ranges from manic to depressive. A fourth digit of 6 is reported when this is documented. A fifth digit must also be assigned indicating the severity of the disorder when one of these fourth digits is assigned. A fourth digit of 7 or 8 indicates a bipolar I disorder of unspecified phase or an unspecified bipolar disorder, respectively. ICD-9-CM code is used to report bipolar II disorders. This drug may also be used in the treatment of pain. ICD-9-CM category 338 Pain, not elsewhere classified, provides subclassification codes that enable reporting of specific underlying causes of pain, as well as its acuity or chronicity. Category 338 contains an instructional note to coders to use an additional code (307.89) to identify pain associated with psychological factors. It also contains an exclusions note for generalized and localized pain, as well as pain disorder exclusively attributed to psychological factors Bipolar I disorder, most recent episode (or current) manic, mild (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Bipolar I disorder, most recent episode (or current) manic, moderate (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Bipolar I disorder, most recent episode (or current) manic, severe, without mention of psychotic behavior (Use Bipolar I disorder, most recent episode (or current) manic, severe, specified as with psychotic behavior (Use Bipolar I disorder, most recent episode (or current) mixed, mild (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Bipolar I disorder, most recent episode (or current) mixed, moderate (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Bipolar I disorder, most recent episode (or current) mixed, severe, without mention of psychotic behavior (Use Bipolar I disorder, most recent episode (or current) mixed, severe, specified as with psychotic behavior (Use Procedure Codes Non- Non

8 Procedure Codes Clozapine This drug, also known as Clozaril, is an atypical antipsychotic used to treat severe cases of schizophrenia in which the patient is a threat to themselves and/or others. It changes the activity of certain chemical processes in the brain. Agranulocytosis is the most common side effect and therefore white blood cell and absolute neutrophil count are required weekly for the first six months, biweekly for the second six months, and every four weeks after a year of being maintained on clozapine. Blood specimen is collected by venipuncture usually during the trough period. Methods include liquid chromatography and tandem mass spectrometry. This code is new for This test is quantitative. To report nonquantitative testing, see If specimen is transported to an outside laboratory, report for handling or conveyance. Schizophrenia is not diagnosed unless there is characteristic disturbance of at least two of these areas: thought, perception, mood, conduct, and personality. The first axis of coding schizophrenia is to identify the type (e.g., simple, disordered, paranoid, latent, residual, etc.). Identify the course of illness with a fifth digit, as follows: 0 Unspecified, 1 Subchronic state: continuous for more than six months but less than two years, 2 Chronic state: continuous for more than two years, 3 Subchronic with acute exacerbation: continuous for more than six months but less than two years but psychotic features have resurfaced in patient who has been in residual phase, 4 Chronic with acute exacerbation: continuous for more than two years but psychotic features have resurfaced in patient who has been in residual phase and, 5 In remission: history of schizophrenia but free from symptoms, regardless of whether patient is currently on medication. When the medical record documentation indicates that the patient suffered an overdose of the drug, either accidental or as a suicide attempt, see the Table of Drugs and Chemicals to locate the appropriate external cause (E) code Simple schizophrenia, unspecified condition (Use Simple schizophrenia, subchronic condition (Use Simple schizophrenia, chronic condition (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to ) Simple schizophrenia, subchronic condition with acute exacerbation (Use additional code to identify any E853.8 E939.3 E950.3 E980.3 V72.60 associated physical disease, injury, or condition affecting the brain with psychoses Simple schizophrenia, chronic condition with acute exacerbation (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Simple schizophrenia, in remission (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to ) Disorganized schizophrenia, subchronic condition (Use Disorganized schizophrenia, chronic condition (Use Disorganized schizophrenia, subchronic condition with acute exacerbation (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Disorganized schizophrenia, chronic condition with acute exacerbation (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Disorganized schizophrenia, in remission (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to ) Poisoning by other antipsychotics, neuroleptics, and major tranquilizers (Use additional code to specify the effects of poisoning) Accidental poisoning by other specified tranquilizers Other antipsychotics, neuroleptics, and major tranquilizers causing adverse effect in therapeutic use Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents Poisoning by tranquilizers and other psychotropic agents, undetermined whether accidentally or purposely inflicted Laboratory examination, unspecified Coding and Payment Guide for Behavioral Health Services Non- Non

9 Coding and Payment Guide for Behavioral Health Services Desipramine This drug is also known as Norpramin and is among the tricyclic antidepressants. Steady state test specimens are frequently collected at the trough period, which is about 12 hours after the last dose when serum concentration is at its lowest. This is an effective approach to determine a therapeutic level of drug. Overdose is also a reason to run this test. Method is high performance liquid chromatography (HPLC) or gas liquid chromatography (GLC). For nonquantitative testing, see To report the professional services for drug management, see HCPCS Level II code M0064, CPT code 90863, the appropriate level of E/M service, or the appropriate psychotherapy with E/M service code. Follow third-party payer guidelines when selecting the appropriate code for these services. Episodic mood disorders (classified to category 296 in ICD-9-CM) are recurrent, severe disturbances of mood accompanied by one or more of the following: delusions, perplexity, disturbed attitude to self, or disorder of perception and behavior. While subcategories identify the type (e.g., manic or major depressive, bipolar, etc.) and episodic nature (e.g., single, recurrent, etc.) of the disorder, the fifth-digit assignment identifies severity of the episode Major depressive disorder, single episode, mild (Use Major depressive disorder, single episode, moderate (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Major depressive disorder, single episode, severe, without mention of psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition Major depressive disorder, single episode, severe, specified as with psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition Major depressive disorder, single episode in full remission (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Major depressive disorder, recurrent episode, mild (Use Major depressive disorder, recurrent episode, moderate (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Major depressive disorder, recurrent episode, severe, without mention of psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to ) Major depressive disorder, recurrent episode, severe, specified as with psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to ) Major depressive disorder, recurrent episode, in full remission (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Bipolar I disorder, most recent episode (or current) depressed, moderate (Use additional code to identify any associated physical disease, injury, or condition Bipolar I disorder, most recent episode (or current) depressed, severe, without mention of psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Bipolar I disorder, most recent episode (or current) depressed, severe, specified as with psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Bipolar I disorder, most recent episode (or current) depressed, in full remission (Use additional code to identify any associated physical disease, injury, or condition Obsessive-compulsive disorders Dysthymic disorder Procedure Codes Non- Non

10 Procedure Codes Dipropylacetic acid (valproic acid) This drug is also known as Depakene. This drug is often used to treat seizures. Test specimens are frequently collected at the trough period, which is about 12 hours after the last dose when serum concentration is at its lowest. This is an effective approach to determine a therapeutic level of drug. Method is gas liquid chromatography (GLC), gas chromatography-mass spectrometry (GC-MS), and enzyme immunoassay (EIA). This examination is quantitative. For nonquantitative testing, see To report the professional services for drug management, see HCPCS Level II code M0064, CPT code 90863, the appropriate level of E/M service, or the appropriate psychotherapy with E/M service code. Follow third-party payer guidelines when selecting the appropriate code for these services. If a specimen is transported to an outside laboratory, report for handling or conveyance. Epilepsy is a disorder characterized by recurrent transient disturbances of the cerebral function. An abnormal paroxysmal neuronal discharge in the brain usually results in convulsive seizures, but may result in loss of consciousness, abnormal behavior, and sensory disturbances in any combination. Epilepsy may be secondary to prior trauma, hemorrhage, intoxication (toxins), chemical imbalances, anoxia, infections, neoplasms, or congenital defects. The ICD-9-CM alphabetic index provides guidance regarding appropriate code assignment for single, recurrent or repetitive seizures and seizure disorder. Accordingly, a single seizure is reported with code Recurrent or repetitive seizures are reported with code 345.9x Epilepsy, unspecified. Report code 345.9x Epilepsy, unspecified, for seizure disorder, not otherwise specified, and recurrent seizures. While subcategories identify the specific type of seizure, fifth-digit assignment identifies if intractable epilepsy is present: 0 Without mention of intractable epilepsy, 1 With intractable epilepsy. bipolar disorder. Manic-depressive psychosis that has appeared in both the depressive and manic form, either alternating or separated by an interval of normality. Atypical: Episode of affective psychosis with some, but not all, of the features of the one form of the disorder in individuals who have had a previous episode of the other form of the disorder. intractable. Resistant to relief. status epilepticus. More than 30 minutes of continuous seizure or multiple sequential seizures without a return to consciousness in between. Treatment usually begins after five minutes of seizure activity Bipolar I disorder, single manic episode, unspecified (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Bipolar I disorder, single manic episode, mild (Use Bipolar I disorder, single manic episode, moderate (Use Bipolar I disorder, single manic episode, severe, without mention of psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition Bipolar I disorder, single manic episode, severe, specified as with psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition Bipolar I disorder, most recent episode (or current) manic, unspecified (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Bipolar I disorder, most recent episode (or current) manic, mild (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Bipolar I disorder, most recent episode (or current) manic, moderate (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Bipolar I disorder, most recent episode (or current) manic, severe, without mention of psychotic behavior (Use Bipolar I disorder, most recent episode (or current) manic, severe, specified as with psychotic behavior (Use Coding and Payment Guide for Behavioral Health Services Non- Non

11 Coding and Payment Guide for Behavioral Health Services Doxepin This drug is also known as Sinequan or Adapin. This drug is classified as a tricyclic antidepressant (TCA). Steady state test specimens are frequently collected at the trough period, which is about 12 hours after the last dose when serum concentration is at its lowest. This is an effective approach to determine a therapeutic level of drug. Overdose may also prompt this test. Method is high performance liquid chromatography (HPLC), gas liquid chromatography (GLC), gas chromatography-mass spectrometry (GC-MS), and radioimmunoassay (RIA). This examination is quantitative. For nonquantitative testing, see To report the professional services for drug management, see HCPCS Level II code M0064, CPT code 90863, the appropriate level of E/M service, or the appropriate psychotherapy with E/M service code. Follow third-party payer guidelines when selecting the appropriate code for these services. If a specimen is transported to an outside laboratory, report for handling or conveyance. Episodic mood disorders (classified to category 296 in ICD-9-CM) are recurrent, severe disturbances of mood accompanied by one or more of the following: delusions, perplexity, disturbed attitude to self, or disorder of perception and behavior. While subcategories identify the type (e.g., manic or major depressive, bipolar, etc.) and episodic nature (e.g., single, recurrent, etc.) of the disorder, the fifth-digit assignment identifies severity of the episode Major depressive disorder, single episode, moderate (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Major depressive disorder, single episode, severe, without mention of psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition Major depressive disorder, single episode, severe, specified as with psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition Major depressive disorder, single episode in full remission (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Major depressive disorder, recurrent episode, mild (Use Major depressive disorder, recurrent episode, moderate (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Major depressive disorder, recurrent episode, severe, without mention of psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to ) Major depressive disorder, recurrent episode, severe, specified as with psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to ) Major depressive disorder, recurrent episode, in full remission (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Bipolar I disorder, most recent episode (or current) depressed, mild (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Bipolar I disorder, most recent episode (or current) depressed, moderate (Use additional code to identify any associated physical disease, injury, or condition Bipolar I disorder, most recent episode (or current) depressed, severe, without mention of psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Bipolar I disorder, most recent episode (or current) depressed, severe, specified as with psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Bipolar I disorder, most recent episode (or current) depressed, in full remission (Use additional code to identify any associated physical disease, injury, or condition Procedure Codes Non- Non

12 Procedure Codes Haloperidol This drug, also known as Haldol, is a well-established tranquilizer with antipsychotic and other properties. Blood concentrations of haloperidol do not correspond well with therapeutic dosages; therefore, assays may be performed to establish compliance or to measure the body's ability to metabolize the drug. Methods may include high performance liquid chromatography (HPLC), gas liquid chromatography (GLC), and radioimmunoassay (RIA). This examination is quantitative. See for nonquantitative testing. If a specimen is transported to an outside laboratory, report for handling or conveyance. To report the professional services for drug management, see HCPCS Level II code M0064, CPT code 90863, the appropriate level of E/M service, or the appropriate psychotherapy with E/M service code. Follow third-party payer guidelines when selecting the appropriate code for these services. Schizophrenia is not diagnosed unless there is characteristic disturbance of at least two of these areas: thought, perception, mood, conduct, and personality. The first axis of coding schizophrenia is to identify the type (e.g., simple, disordered, paranoid, latent, residual, etc.). Identify the course of illness with a fifth-digit, as follows: 0 Unspecified, 1 Subchronic state: continuous for more than six months but less than two years, 2 Chronic state: continuous for more than two years, 3 Subchronic with acute exacerbation: continuous for more than six months but less than two years but psychotic features have resurfaced in patient who has been in residual phase, 4 Chronic with acute exacerbation: continuous for more than two years but psychotic features have resurfaced in patient who has been in residual phase, and 5 In remission: history of schizophrenia but free from symptoms, regardless of whether patient is currently on medication Simple schizophrenia, subchronic condition (Use Simple schizophrenia, chronic condition (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to ) Disorganized schizophrenia, subchronic condition (Use Disorganized schizophrenia, chronic condition (Use Paranoid schizophrenia, subchronic condition (Use Paranoid schizophrenia, chronic condition (Use Schizophreniform disorder, subchronic (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to ) Schizophreniform disorder, chronic (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to ) Latent schizophrenia, subchronic condition (Use Latent schizophrenia, chronic condition (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to ) Schizophrenic disorders, residual type, subchronic (Use Schizophrenic disorders, residual type, chronic (Use Schizoaffective disorder, subchronic (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to ) Schizoaffective disorder, chronic (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to ) Coding and Payment Guide for Behavioral Health Services Non- Non

13 Coding and Payment Guide for Behavioral Health Services Imipramine This drug may also be known as Tofranil. The drug is classified as a tricyclic antidepressant (TCA). Steady state test specimens are frequently collected at the trough period, which is about 12 hours after the last dose when serum concentration is at its lowest. This is an effective approach to determine a therapeutic level of drug. Overdose may also prompt this test. Method is high performance liquid chromatography (HPLC), gas liquid chromatography (GLC), gas chromatography-mass spectrometry (GC-MS), and radioimmunoassay (RIA). This examination is quantitative. For nonquantitative testing, see To report the professional services for drug management, see HCPCS Level II code M0064, CPT code 90863, the appropriate level of E/M service, or the appropriate psychotherapy with E/M service code. Follow third-party payer guidelines when selecting the appropriate code for these services. Episodic mood disorders (classified to category 296 in ICD-9-CM) are recurrent, severe disturbances of mood accompanied by one or more of the following: delusions, perplexity, disturbed attitude to self, disorder of perception and behavior. While subcategories identify the type (e.g., manic or major depressive, bipolar, etc.) and episodic nature (e.g., single, recurrent, etc.) of the disorder, the fifth-digit assignment identifies severity of the episode Major depressive disorder, single episode, mild (Use Major depressive disorder, single episode, moderate (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Major depressive disorder, single episode, severe, without mention of psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition Major depressive disorder, single episode, severe, specified as with psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition Major depressive disorder, single episode in full remission (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Major depressive disorder, recurrent episode, moderate (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Major depressive disorder, recurrent episode, severe, without mention of psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to ) Major depressive disorder, recurrent episode, severe, specified as with psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to ) Bipolar I disorder, most recent episode (or current) depressed, mild (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Bipolar I disorder, most recent episode (or current) depressed, moderate (Use additional code to identify any associated physical disease, injury, or condition Bipolar I disorder, most recent episode (or current) depressed, severe, without mention of psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Bipolar I disorder, most recent episode (or current) depressed, severe, specified as with psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Bipolar I disorder, most recent episode (or current) depressed, in full remission (Use additional code to identify any associated physical disease, injury, or condition Atypical depressive disorder (Use additional code to identify any associated physical disease, injury, or condition Dysthymic disorder Poisoning by tricyclic antidepressants Procedure Codes Non- Non

14 Procedure Codes Lithium This drug may also be known as Eskalith. Lithium is a naturally occurring mineral and its salts may be used in the treatment of mental disorders, in particular bipolar depression. Steady state test specimens are frequently collected at the trough period, which is about 12 hours after the last dose when serum concentration is at its lowest. This is an effective approach to determine a therapeutic level of drug. Methods may include flame emission spectroscopy (FES), atomic absorption spectrophotometry (AAS), and ion-specific electrode (ISE). This examination is quantitative. See for nonquantitative testing. To report the professional services for drug management, see HCPCS Level II code M0064, CPT code 90863, the appropriate level of E/M service, or the appropriate psychotherapy with E/M service code. Follow third-party payer guidelines when selecting the appropriate code for these services. If a specimen is transported to an outside laboratory, report for handling or conveyance Major depressive disorder, single episode, mild (Use Major depressive disorder, single episode, moderate (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Major depressive disorder, single episode, severe, specified as with psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition Major depressive disorder, single episode, in partial or unspecified remission (Use additional code to identify any associated physical disease, injury, or condition Major depressive disorder, single episode in full remission (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Major depressive disorder, recurrent episode, mild (Use Major depressive disorder, recurrent episode, moderate (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Major depressive disorder, recurrent episode, severe, specified as with psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to ) Major depressive disorder, recurrent episode, in partial or unspecified remission (Use additional code to identify any associated physical disease, injury, or condition Major depressive disorder, recurrent episode, in full remission (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Bipolar I disorder, most recent episode (or current) depressed, mild (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Bipolar I disorder, most recent episode (or current) depressed, moderate (Use additional code to identify any associated physical disease, injury, or condition Bipolar I disorder, most recent episode (or current) depressed, severe, specified as with psychotic behavior (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses Bipolar I disorder, most recent episode (or current) depressed, in partial or unspecified remission (Use Bipolar I disorder, most recent episode (or current) depressed, in full remission (Use additional code to identify any associated physical disease, injury, or condition Atypical depressive disorder (Use additional code to identify any associated physical disease, injury, or condition Coding and Payment Guide for Behavioral Health Services Non- Non