2013 CPT Code Changes Frequently Asked Questions

Transcription

1 Are codes for higher levels of care (e.g. H0015, H2035, and H0018) impacted at all by these CPT code changes, or will these remain the same on contracts for those services? Procedure codes H2022 and H0046 U7 SC will not be changing? These codes are used for school program. No, only the traditional outpatient codes are affected at this time. All other services remain unchanged. No, these service codes will not change. Do you know if VBH will be eliminating any H codes No, any H codes will remain unchanged. that are in place now? Will there be any changes to the H0015 (IOP) code? No, there will not be a change to H0015. Should master's level clinicians continue to use H0031AJ for the initial interview? What about the and H0031 are those codes still valid and usable? Should a master's level clinician continue to use code H0031, or in the case of an initial interview? For code 99211, does the nurse need to be specifically licensed as a psychiatric nurse? Can the be used for a bachelor's level counselor if the service is billed under the facility and not the individual counselor? When billing as a clinic, can we use our non-licensed master's and bachelor's level therapists to perform services under 90791? With these new codes, can a bachelor's level therapist perform the Intake appointment? H Codes Master's Yes, for the diagnostic interview, a master's level clinician will continue to use H0031 AJ. As above, H0031 AJ is valid as the code to be used for master's level clinicians to use for the diagnostic interview. Psychologist will use for a diagnostic interview and psychiatrist will have the ability to use If the master's level clinician is an individually contracted provider with VBH-PA, H0031 AJ is the code to use for the diagnostic interview. This does not apply to those individuals who work a facilities; facilities do not use codes with AJ modifiers. License will be added to facility amendments and to those nurse practitioners in private practice. If you are a facility please use the UB modifier as assigned per your contract amendment. No, the nurse does not have to be specifically licensed as a psychiatric nurse. However, the nurse must follow their specific licensing rules. Yes, is the code for psychiatric diagnostic evaluation that does not require medical services and therefore can be utilized for the intake by a bachelor's level counselor who works in a facility. As a clinic you can use a bachelor's level therapist for the intake. The service code to use is A bachelor's level therapist can perform the intake appointment only within a clinic. The service code that should be used is

2 Can you please explain the difference between the H Within Codes a facility, may be billed by a psychiatrist, nurse and codes. The are for all rendering practitioner, physician assistant, psychologist, social worker, providers, however, the are for MD and CRNP licensed professional counselor or master's level clinician or a if they perform a medical exam? bachelor's level clinician if no medical services are provided can only be used by a psychiatrist, nurse practitioner or physician assistant when medical services are provided. Only persons with prescriptive authority are able to use and in doing so must include medical services. Does a psychiatrist have to be on-site at all times to bill for services provided by Physician's Assistant or CRNP? Are we going to need new authorizations to reflect the new codes? Do we need to get special precert if a patient is seen by a doctor and therapist on the same day? The crosswalk does not have the new CPT code that replaces the old CPT code. I also didn't see a new CPT code that replaces Summer Camp Evaluations in which uses the old CPT code. Since the old code is not listed on the crosswalk, have the unit(s) changed? What are the codes for Initial Evaluations and Re- Evaluations for BHRS changing to? Will this also impact BHRS evaluations? The codes for Beaver, Butler and Lawrence for an initial eval U4 remain the same? Is the psychologist code we currently use going to change? It is with no modifier. It is service class Y96. One E & M per day question. Patient sees psychiatrist for medication management and then needs to go to PCP for a physical evaluation. Is this permissible? Physicans and facilities must follow the oversight regulations that govern their license and the PA Code Authorizations No, the authorizations that are currently in the system will remain active. We are adding the new service codes to the current service classes. A patient can see a doctor and a therapist on the same day. Follow the normal authorization process. BHRS Providers should use U4 for the BHRS Evaluation code. The unit value has changed from 30 minutes to Per Occurrence. At this time, the Summer Camp Evaluation Code has been eliminated. For BHRS the initial evaluation the service code will be U4 per occurrence. For the Re-Evaluation the service code is UC per occurrence. The impact will be with the evaluation. The service code for the initial evaluation is U4 and the Re-Evaluation is UC. Both codes are per occurrence. No, this service code will change to U4 per occurrence. Yes, no modifier will now be U4 (per occurrence). The service class will change to TXS. Evaluation & Management Yes, the patient can see both the psychiatrist for a medication management and see their PCP for a physical evaluation. These are two different services billed to two different MCO's.

3 Must a "comprehensive exam" include a musculoskeletal exam? Does the E/M codes take over for 90862? H Codes Yes. Please refer to the CMS documentation guideline for E&M Services code definitions of the E&M codes. Learning-Network- MLN/MLNProducts/downloads/eval_mgmt_serv_guide- ICN pdf Yes, will not longer be accepted for dates of service January 1, 2013 forward. The E/M codes are required. Is it true that you can not bill individual therapy and a med check on the same day with different providers? Are outpatient providers able to provide a medication check and an individual session on the same day? This is not true. E&M codes include "counseling". If therapy is being provided by a physician during a "med check", it should be billed using the appropriate E&M code. Two E&M codes cannot be billed the same day. If a therapist conducts an individual therapy session on the same day in the same agency, the two services must be supported with clinical documentation and supported by encounter forms. In other webinars they gave a range of time for the various therapy codes - ex Psychotherapy 30 minutes is listed as therapy with a duration of 16 to 37 minutes. Is VBH deviating from these definitions? VBH-PA is following the definitions as outlined in the CPT manual. Is there a minimum length of time for such as 53 The unit value of (plus modifier in some cases) is 60 minute minimum? minutes. Bill according to the unit value. The new therapy codes - can we only bill with Bill according to the unit value. durations of 30,45 & 60. Or should they bill with actual duration (EX: 35 min would bill as 30) Will there be any way to "add on" to a (individual hour) in order to cover a 90 min session should it be necessary to run over the hour? Durations Add on codes Add On codes have been introduced as part of the CPT Code Changes of They are codes billed in addition to primary codes and cannot stand alone. In order to simplify the changes, VBH-PA is not utilizing Add On codes. If you routinely, and for a therapeutic reason, exceed 60 minutes, please contact your Provider Field Coordinator. If you do a med check and add a 90833, how long would the need to be? VBH-PA will not be utilizing the "add on" codes with the E & M codes.

4 I participated in the United Behavioral Health Webinar H No, Codes at this time VBH-PA will not be utilizing the "add on" yesterday. They are going to reimburse for a with codes. add on code of plus the code. This would be a med check with 30 minutes of psychotherapy. Is this going to be a reimbursable code for Value contracted providers? Is VBH not using new CPT at all? You did not discuss 90840, psychotherapy for crisis which is a completely new service. Can you discuss? What about the new crisis code 90839? Will VBH be adding this with our amendment? Are we to hold charges until we receive amendment agreements? Will each individual provider receive an updated fee schedule for their services and their contracted counties? I believe it was stated - do not submit billing until we have received our new amended contract? So we are supposed to hold all billing from January 1, 2013 to possibly mid-january or whenever we receive our new contract and not submit until then - is that correct? No, at this time VBH-PA will not be utilizing the "add on" codes. Crisis VBH-PA will not be utilizing the new codes that have been added for psychotherapy for a patient in crisis. We will continue to use our existing crisis codes since this is a service that is reportable to DPW. VBH-PA will not be utilizing the new codes that have been added for psychotherapy for a patient in crisis. We will continue to use our existing crisis codes since this is a service that is reportable to DPW. Holding Billing Yes; however, all contract amendments have been sent out to providers. If you have no received yours, please contact your Provider Field Coordinator. All contract amendments have been sent out to providers. They reflect the new CPT codes and they include the contracted counties. Yes, please hold your billing for traditional outpatient services until you receive and return your signed contract amendment. If you provide other services in addition to outpatient services you can bill for these services. Will I be able to use the new CPT codes for dates of service prior to January 1, 2013? No, please use the old code set for any dates of service prior to January 1, 2013, even if the claim is submitted in Will the code be used? It is a 53 minute session code. Why would you use a versus a 99203? Specific Codes (with a modifier in some cases) will be used. It's a 60 minute individual psychotherapy session. It replaces (with a modifier in some cases) includes the medication management, does not. Can you bill multiple units for an individual code - example 90834? I received an amendment agreement for Fayette that has U4 for eval, this is not on the crosswalk, does this not apply to Fayette? No, you cannot bill for multiple units U4 will not be used for any county going forward.

5 Is the difference between 99202/03 and 99212/13 have H Yes, Codes is for New patients and 99212/13 are for to do with new versus established? Established patients. Please refer to the CPT code descriptions for a more detail explanation. How will the PCIT codes be affected by these changes, The PCIT service codes will change. The HR modifier will e.g HR? remain, e.g HR will replace HR. Please explain the use of cpt codes through is Individual Therapy (30 minutes). This code replaces would these codes be used in place of (20-30). and as the explanation of those codes were is Individual Therapy (45 minutes). The code replaces individual and/or family and the 90846/90847 are (45-50). plain family codes is Individual Therapy (60 minutes). This code replaces (75-80) Family Therapy without the patient is a 15 minute code and this has not changed is Family Therapy with the patient is a 15 minute code and this has not changed is Group Therapy is a 15 minute code and this has not changed. Is the code changing? What about the use of M0064 in place of 90862? This was mentioned at a seminar last week from VBH. Can this code be used? And in what instance? Can a patient have both a and later have a 90792? For the previous code (75 minute) we could not bill multiple units. Can we bill multiple untis now? No, this code will not change. At this time M0064 is not a reportable code to DPW. This code may be used by other insurance companies to include our parent company, ValueOptions, but at this time VBH-PA is not using this service code. Yes. You cannot bill for multiple units of 90832, and I see specific codes for sex offender therapy, group, etc. what set of codes is to be used for victims of sexual abuse (as in, which modifiers?) Are you still using the UB and AJ modifiers in the appropriate crosswalk code? What constitutes a "new patient"? The truest sense of the word - never been seen? Also, when a client has been discharged and comes back into treatment are they considered an existing client or new? Modifiers Please refer to your contract for a detailed description of the service codes and modifiers that you are contracted for. Yes, we will use the modifiers where appropriate. Please be sure to review your contract. Miscellaneous A new patient is someone who has never been seen at that facility or a client who has not been seen by the facility in three years. Will these new codes also be used if we are billing directly to Medical Assistance? Are these codes for all insurance companies across the board? Please contact Pennsylvania Medical Assistance regarding this question. These codes are only for VBH-PA. Please check with each insurance company to determine what they will be using.

6 If we are currently contracted with VBH (Medicaid managed care) as well as Value Options (commercial) do these code changes apply to both products? If so, can we expect an Amendment from each? H Codes No, these changes only apply to VBH-PA. Please contact your provider relations contact for ValueOptions commercial accounts. What counties will the CPT code change affect? This change affects the following counties that VBH-PA manages Behavioral Health Services: Armstrong/Indiana, Beaver, Butler, Cambria, Crawford, Fayette, Greene, Lawrence, Mercer, Venango, Washington and Westmoreland.