There are some very important coding changes that took place after the 2013 Behavioral Health MultiBook went to press.
To assist our customers in understanding these changes, the appropriate corrections documents are being made available for subscribers only and new Quick Reference Cards are being prepared. Go to the subscriber section (www.instacode.com/bh/BHB-login) in order to access this information.
Prolonged Services Changes
In an official AMA Corrections document dated “December 12, 2012”, several critical changes were made which affect psychiatric services coding. These changes also make our Quick Reference card inaccurate. Most significantly, the Prolonged Services codes can now be used in conjunction with code 90837 when services extend beyond 90 minutes. The AMA parenthetical instructions for using Prolonged Services codes has been removed from code 90838.
This is good news for the many times that a psychotherapy session extends beyond 90 minutes. In these situations, bill both 90837 and a Prolonged Services code [99354-99357] together on the claim. CLICK HERE to read more about billing add-on codes.
Please note that these official AMA corrections will not be shown in a CPT code book because of this late change.
Many payers rely heavily on NCCI edits for reimbursement decisions. What could be a problem, is that effective January 1, 2013, NCCI edits are not entirely consistent with these official changes. Providers may need to work with insurance payers regarding these official CPT code changes when inconsistencies arise in payment.
If you encounter incorrect denials, work with your professional organization to clear up these problems.
For example, code 90838 still lists the Prolonged Services codes as being reimbursable when billed with the prolonged services codes. However, the NCCI edit for code 99354 (prolonged services) shows 90838 as non-reimbursable.
Code 90837, which should now be listed as reimbursable in these edits, does not list prolonged services codes as being either reimbursable or non-reimbursable. However, the edits for code 99354 (prolonged services) show codes 90833, 90836 as reimbursable but does not list 90837 as either reimbursable or non-reimbursable, even though it should now be listed as reimbursable. If a payer is strictly following NCCI edits, it is possible that they may deny payment on code 99354 when both 90837 and 99354 are submitted together on a claim.
The 2013 Behavioral Health MultiBook's "NCCI update pages" are currently being created and will be posted in the subscriber section by January 15th, if not earlier. To access this information go the subscriber section (www.instacode.com/bh/BHB-login). We will complete these as quickly as possible to make this important information available.
Quick Reference Card Corrections
There are a few corrections to the Quick Reference Card. To download the new version of the Quick Reference Card, you will need to be logged into the subscriber pages (see above).
- “MAPPING PREVIOUS PSYCHIATRIC SERVICE CODES TO 2013” side:
- Everywhere it says code 90875, it should be 90785. This typo managed to slip past the editors.
- References to using Prolonged Services with code 90837 will be included where applicable.
- Code 90826 incorrectly showed code 90785 two times.
- “PSYCHOTHERAPY CODING FLOWCHART” side:
With the addition of code 90837 to Prolonged Services, instead of the arrow going from the “Report Psychotherapy Time” box to the “Is Interactive Complexity Present” question box, it now goes from the "Report Psychotherapy Time" box to the “Is this a Prolonged Service” question box.
The information presented here is based on currently available information regarding CPT codes and guidelines as copyrighted by the American Medical Association. It does not supercede state licensing board's ethical guidelines, or local, state, and/or national regulations and/or laws. Be aware that individual third-party payer policies can vary from these standards. InstaCode Institute will post notifications of changes or updates on their website. It is the individual reader's responsibility to check for revisions.