Reimbursement Rates and Medical Coding

Reimbursement rates and medical coding can be almost as complicated as treating some mental illnesses. As a PMHNP, you will be faced with varying rates that may be different than other health care providers you may work with. Reimbursement Rates and Medical Coding

In this Practicum Journal Assignment, you will analyze reimbursement rates for mental health treatments you will likely use in your practice and compare those rates to other provider rates.

Learning Objectives

Students will:

Analyze reimbursement rates for mental health treatments
To prepare for this Practicum Journal:

Research reimbursement rates for various treatment modalities.
Compare NP rates to other provider rates.
For this Practicum Journal:

Complete the Reimbursement Rate Template in your Learning Resources using the five types of services you are likely to use in your practice. Reimbursement Rates and Medical Coding

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The CPT coding system is used to provide a description of medical services for facilitation of more effective communication between patients, healthcare providers, and the third-party payers such as the insurance companies. In this assignment, reimbursement rates for mental health treatments will be analyzed, followed by completion of reimbursement rate template on the type of services likely to be used during practice.

Psychiatric Diagnostic Evaluation (90791)

The code is utilized during the first diagnostic assessment with the client and does not encompass medical services. The code consists of the chief complaint, HPI, systems review, mental status assessment, family history, psychosocial history, and interpretation of lab or other diagnostic findings (Michale et al, 2014). Currently, this code can be billed for subsequent days and Medicare only pays for a single 90791 annually for patients who are institutionalized unless medical requirement is determined for others.

Individual Psychotherapy (30 min)-Outpatient (90832)

The billing for this code is based on the time spent during psychotherapy with the client or the family member. If a therapist spends more than 15 minutes with a client, code 90832 is used for billing and also if the client is seen for 35 minutes, code 90832 will still be used. Time the healthcare provider uses in provision of assessment and management services is not included when establishing the time used in psychotherapy provision (American Medical Association, 2017).

Family Psychotherapy (Patient Present) (90847)

Therapists use this code when therapy is provided to the client along with the family members. This code is also used in billing psychotherapy provided to couples. This code is rarely challenged since the client is always present during therapy provision (American Medical Association, 2017).

Group Psychotherapy (90853)

This code is used when therapy is provided to group members in order to assess the pathology of every group person in the group. Additionally, the therapist notes the dynamics of the whole group, behavior modification and examining the attitudes of individual members. The group size is dependent on the group’s therapeutic goals or the therapeutic interactions that the therapist will use. When using this code, the therapist bills per session services for every member of the group (APA, 2016). Reimbursement Rates and Medical Coding

Electroconvulsive Therapy (90870)

This code is used when the therapist provides electric current to the brain of the client in order to produce a seizure in order to do away with the mental symptoms. A therapist used electroconvulsive therapy when a client with depression fails to respond to medical treatment (American Medical Association, 2017). The code also covers the time the healthcare provider uses in monitoring the client during the convulsive duration as well as the recovery duration. However, in case anesthesia is administered during electroconvulsive therapy, anesthesia is billed separately using an anesthesia code. This code also covers Necessary Monitoring (APA, 2016).

References

American Medical Association (2017). Fee Schedule For Community/Private Mental Health Centers, Effective July 1, 2018. Chicago: American Medical Association.

APA (2016). CPT Coding and Documentation Update – CPT Coding for Psychiatric Care in 2016. APA.

Michale S, Peter W & Kyle G. (2014). An Examination of Costs, Charges, and Payments for Inpatient Psychiatric Treatment in Community Hospitals. Psychiatric Services. 63(7). Reimbursement Rates and Medical Coding

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