Insurance codes for mental health services are an important part of every practice. For providers that accept insurance, understanding how to use and apply insurance codes is the fastest way to full and timely reimbursements. When knowledge of such details is lacking, your bottom line suffers, and your practice cannot grow. What are insurance codes for mental health services?
What are Insurance Codes?
There are three types of insurance codes across the healthcare and mental health services industries. These are CPT (Current Procedural Terminology) codes, ICD-10 (International Classification of Diseases and Related Health Problems) codes, and DSM-5 codes. Each set of codes is meant to create a common language for mental and healthcare providers when communicating treatments, diseases, procedures, evaluations, and more.
The only codes that therapists should use to bill for mental health services are ICD-10 codes. The DSM is used by all mental health providers to aid in the diagnosing of clients/patients with mental health conditions and aligns closely with insurance billing codes, but are not the same.
Knowledge of the ICD-10 guide to billing is essential for ensuring that your practice maximizes its claims. All insurance companies use and require these codes in claims in order to distribute reimbursement. These codes are formatted the same across all services starting with a single letter, followed by three or more numbers. The letter determines the category of mental health services and the number narrows it down precisely to the correct services. The correct application of these codes is how providers get paid by insurance organizations after providing mental health services.
Common Insurance Codes for Mental Health Services:
90837 – Psychotherapy, 60 minutes
90834 – Psychotherapy, 45 minutes
90791 – Psychiatric diagnostic evaluation without medical services
90847 – Family psychotherapy (with client present), 50 minutes
90853 – Group psychotherapy (other than of a multiple-family group)
90846 – Family psychotherapy (without the client present), 50 minutes
90875 – Under other psychiatric services or procedures
90832 – Psychotherapy, 30 minutes
90838 – Psychotherapy, 60 minutes, with E/M service
99404 – Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure)
Pitfalls with Mental Health Services Billing
Coding a claim correctly is the quickest path to billing, yet so many providers find themselves struggling to do so. Even the smallest mistake can result in denial with is why it is so important to code each claim with caution and attention.
Frequency of Visits
Seeing a patient/client too often can easily result in a denial of a claim. Depending on their coverage, their insurance might only cover visits conducted over a certain amount of time. Failing to notice this could result in an unpaid claim for mental health services.
Using the Same Insurance Code Too Often
Insurance companies start to get suspicious and ask questions if the same kinds of codes are being used too often. Using a variety of codes for mental health services can help a provider avoid being audited. Billing duplicate diagnosis codes for multiple patients raises another red flag to payers that you are not paying close enough attention to how you are billing. Documenting is your best friend, in this case, to help you avoid being under their microscope.
Codes that Raise Red-Flags
Specific codes for mental health services, when used too often, can also alert an insurance company to think you are up to no good. The three codes that providers should be careful using too often include codes 99215 (individual psychotherapy), 90837 (established patient visit), and 90853 (group psychotherapy). Again, in order to avoid trouble, document as thoroughly as possible why you chose to label your claim with that ICD-10 code.
Billing Tools and Services that Can Help
Mental Health Billing Software
Implementing a quality billing solution for mental health services is an extremely effective way to ensure you are coding your claims accurately. This tool is built with the most used codes in the field and can help a provider discern when to apply the right one.
Billing software for mental health services can also streamline a provider’s workflow by integrating with their other tools and helping them get more work done in less time.
Providers can also find support when it comes time to bill for mental health services by working with a managed billing partner. If the fastest way to get paid is to code claims accurately, the right partner can make sure you do. Managed billing partners are experts in coding claims. They will work diligently to ensure each claim you submit is submitted correctly the first time, resulting in the fastest payment possible. With access to industry experts, providers can worry less about their billing and focus on their clients.
Ready for an EHR to streamline your billing and practice management?