Monthly Archives: January 2013

Psych Secrets

This post is about doing billing for the psychiatrist or psychologist in your life. It’s going to be a long one, guys.

The new CPT codes for mental health services for 2013 are going to have to be a whole post themselves. If you absolutely, positively need an easy explanation before I can get the post up, please remember, you can call or email. The diagnosis that are categorized as mental health conditions range from between ICD9 code 290-319 (ICD10 F01-F99) and if you are not a psych or a therapist and you bill any of these dx primary, you might end up with a denial, so please be careful.

The most important part of the process is the insurance verification. I know that a lot of health plans show the mental health benefits online. Unfortunately, the information they give you online is incomplete, so you are going to be making some calls. The number for the mental health information line is on the back of the card. Also called behavioral health, the people at this number will become your new best friends. Well, at least until you have to call about a claim. Here is where you learn some new terminology. Below is a list of the questions to ask when you’re on the phone with eligibility.

1. Does this plan require authorization?
2. Do the claims carve out?
3. Are there different benefits for parity and non-parity?

A plan carves out when the financial responsibility for mental health services changes from the health plan to another company. For example, Health Net carves out the mental health to CHIPA quite often. So you would send your psychotherapy claim to CHIPA rather than Health Net. You would get your authorization from CHIPA as well. Parity diagnosis are the “serious” ones. I wish I could give you a better definition. Parity dx include most of the chemical imbalances and a few others. Here is the full list, edited for ICD10:

1. Anorexia – 307.1 (ICD10 F50.00 through F50.02)
2. Bipolar Disorder – 296.40 through 296.80 (ICD10 F30.0 through F31.9)
3. Bullimia – 307.51 (ICD10 F50.2)
4. Major Depression – 296.20 through 296.36 (ICD10 F32.0 through F33.9)
5. Obsessive-Compulsive Disorder 300.3 (ICD10 F42)
6. Schizoaffective Disorder – 295.70 through 295.75 (ICD10 F25.0 through F25.9)
7. Schizophrenia – 295.00 through 295.65 (ICD10 F20.0 through F24)

When I was first learning psych billing, I printed this list and taped it to my wall. One of the most useful tools I had.   You also need to know whether you are calling for inpatient or outpatient benefits and substance abuse or mental health. Please remember, all of this information, it is most efficient to get from one phone call. In our office we actually have an insurance verification form that we fill out when we get benefits for new patients. You can use our insurance verification form or you can make your own, but taking a few moments to write down this information saves you from having to call back multiple times. 

Once you have this information, sending the claim out is pretty straightforward. However, if your doctor is contracted with Medicare or Medi-Cal, please give me a call or shoot me an email. There is a LONG explanation regarding getting paid by those companies and it won’t translate well into blog form.

There have been a lot of changes in the psych billing world in the past few years, and it is quite possible that any number of things could have slipped through the cracks in your office. If you still have a lot of money sitting on your AR and your reimbursements aren’t as high as you think they should be,  we can come in and take a look for you, we do that for free. If everything looks fine, we give you a high-five and a few of our cards to pass out to your colleagues. If you do need help, you can hire us to fix it, or we’ll tell you how to fix it yourself. Email me at newgenerationbilling@gmail.com.

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Filed under Authorizations, Billing, CPT, Doctor's Office, Health Care, ICD9, Medi-Cal, Medical Billing, Medicare, Psych

Modifer 25 and 59

We are training several new employees right now. Glad to be expanding, progressing as expected, blah, blah, blah. But they are having a great deal of trouble with understanding when to use the modifiers 25 and 59. If we are having issues in here, some of you out there might be as well, and I want to make your life easier. First, for you technical types here are the exact descriptions from the CPT book.

Modifier 25 – Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service:
It may be necessary to indicate that on the day a procedure or service identified by a CPT code was performed, the patient’s condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. A significant, separately identifiable E/M service is defined or substantiated by documentation that satisfies the relevant criteria for the respective E/M service to be reported (see Evaluation and Management Services Guidelines for instructions on determining level of E/M service). The E/M service may be prompted by the symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not required for reporting of the E/M services on the same date. This circumstance may be reported by adding modifier 25 to the appropriate level of E/M service. Note: This modifier is not used to report an E/M service that resulted in a decision to perform surgery. See modifier 57. For significant, separately identifiable non-E/M services, see modifier 59.

Modifier 59 – Distinct Procedural Service:
Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier 59 is used to identify procedures or services, other than E/M services, that are not normally reported together but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision or excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. However, when another already established modifier is appropriate it should be used rather than modifier 59. Only if no more descriptive modifier is available and the use of modifier 59 best explains the circumstances should modifier 59 be used. Note: Modifier 59 should not be appended to an E/M service. To report a separate and distinct E/M service with a non-E/M service performed on the same date, see modifier 25.

Now for some practical application. The modifier 25 goes on the office visit.  Here are the situtations in which you need a modifier: 1) If a patient gets a procedure on the same day as an office visit, 2) medication injected same day as an office visit, 3) pap smear done same day as an office visit, 4) physical done same day as an office visit. Don’t worry, we’re about to go through and lay out how we are supposed to use them.

If you need to bill an office visit and a procedure, you would use a modifier 25 on the office visit line. A procedure counts as any CPT code between 10000 and 69999. Plus, you need a different diagnosis on the procedure than you have on the office visit. Here is an example:

A patient comes in with ear pain and the doctor diagnoses her with an ear infection and does an ear lavage. If you want to get both the 99213 and the 69210 paid on the same visit here is how you would enter that charge:

Ear pain/otalgia (ICD9 388.70) (ICD10 H92.09)           99213  –  25

Ear infection (ICD9 382.9) (ICD10 H66.90)                   69210

When you put it in with a different dx on the office visit and  a 25 modifier the insurance will pay each line item separately.

Paps and physicals work in a similar way. The medical dx go on the office visit and the V-codes go on the preventive service. I could write a whole post on paps (and probably will) but we are going to keep it simple here.

465.9 (ICD10 J06.9)    462 (ICD10 J02.9)                      99213  –  25

V70.0                                                                               99395

When you need to bill an office visit and an injection on the same day, you have two options. The cpt 96372 is for an intramuscular injection of a J-code. You can bill the office visit and the substance all day and they will all get paid separately with no modifiers. The injection administration is what the insurances like to include in the office visit. However, you will get paid about $20.00 for each administration billed correctly and that can add up. Say a patient comes in with knee pain and the doctor diagnoses him with osteoarthritis and wants to give him an injection of Toradol. You put the symptom on the office visit with a 25 modifier and the substance and the admin have the condition. Then, you put a 59 modifier on the 96372. So, it would be three line items and it would look like this:

Knee pain       719.46 (ICD10 M25.569)                        99213  –  25

Osteoarthritis  715.96 (ICD10 M17.9)                            J1885

Osteoarthritis  715.96 (ICD10 M17.9)                            96372  –  59

I have attached an Updated modifier chart that will tell you when a service needs a modifier. We printed this out and gave it to all the new people and it seemed to clear up most of the confusion.

As always, call or email if you have any specific questions about something that didn’t make it through here on the blog.

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Filed under Billing, Claims, CPT, Health Care, ICD9, Medical Billing, Modifiers

Cash in the Office

Providers love it when their patients pay in cash. There is no waiting weeks, or sometimes months, for an insurance company to decide that you actually get compensated for the services you provide. Cash is easy.

Unfortunately, it is also easy to steal. This post is regretfully inspired by one of our customers. I was thinking of calling this post “If You Don’t Have a Copay Log that You Check  on a Daily Basis, You are Inviting Your Employees to Steal From You.” That was really too long, though.

Doctors, office managers, please, make sure you have some written way of balancing the cash in your hand to the cash you were supposed to have received. Yes, everyone in your office should be trustworthy, and many of them are your friends, and it is very hard to imagine a friend stealing from you. But large amounts of cash are tempting for anyone.

So, here’s how it works. Every patient who pays in cash gets a receipt. Every patient who pays with a check gets a receipt. And every patient who pays with a credit card gets a receipt. The receipts come from a numbered book. Then all patients who paid money are entered on a spreadsheet that includes the date, patient name, payment amount, method of payment, and receipt number. At the end of the day, you have the exact amount of cash in your hand that you have on that spreadsheet and every patient has a sequential receipt number so that you can see no receipts have been pocketed or disposed of.

This will not stop someone who is determined to steal from you. This will enable you to catch it quickly. One of our providers has lost hundreds, if not thousands, of dollars because he did not take our advice to implement this simple procedure. And now he is facing the difficult decision of having to fire one of his friends.

Here is an example of a good Copay Log. One of my office managers has this on her computer, and she adds the patients as they check out.

 

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Filed under Cash, Doctor's Office, Health Care, Loss Prevention, Office policy