Mental health is a critical part of the healthcare infrastructure, providing care for individuals across a broad spectrum of disorders, ranging from anxiety, depression, bipolar disorder, and schizophrenia, among others. As with all healthcare services, the provision of mental health services warrants careful documentation, coding, and billing to ensure they are accurately recorded, evaluated, and reimbursed.
Medical coding is essentially a universal language used by care providers, insurers, and other parties across the healthcare value chain, aimed at accurately documenting the procedures, services, and diagnosis before making claims. In this article, we take a brief look at this hidden layer of global healthcare, that provides a crucial service, and helps keep the system seamlessly chugging along.
Coding Systems For Mental Health Services
The coding systems for mental health is similar to that of general medical services in certain aspects, but differs in a few others due to certain variables that are absent in primary and specialty care services.
On the whole, however, there are two coding systems that are primarily used for mental health services - The International Classification of Diseases (ICD), and The Current Procedural Terminology (CPT). The ICD system concerns itself with the classification and codifying of diagnoses, while the CPT system is used to code procedures and services.
ICD-10 is the latest version of the system, with a new set of codes to classify various mental health disorders. Similarly, CPT undergoes its own revisions at regular intervals to keep up with and accommodate changes in healthcare services and procedures.
Examples of CPT Codes For Mental Health Services
To get a better understanding of how these codes work and fit into the broader healthcare billing and management systems, here are some common examples, pertaining to mental health services particularly.
Psychiatric Diagnostic Interview
Code 90801: Psychiatric diagnostic interview / examination
Code 90802: Interactive diagnostic interview / examination
CPT Code Modifiers
CPT codes allow for certain variables and modifiers to suit different circumstances, which provide more information to the insurer.
Modifier GT: This denotes the use of telehealth sessions for treatments or diagnostics, either via phone call, or through video conferencing.
Modifier UT: Used in cases of emergencies, when the care provider attends to a patient who is visibly in crisis, requiring immediate medical intervention.
Documentation Requirements For Mental Health Services
While the codes and their respective systems play a critical role in medical billing, there are other documentation requirements which are essential for a successful claims process. These documentations essentially support the claims as and when they are raised, and should ideally include the following information,
- Patient Information - All relevant patient details, including name, date of birth, address, occupation, and insurance information, among other things.
- Diagnosis - The relevant diagnosis recorded as per the latest and most appropriate ICD code, factoring-in all relevant factors and variations as applicable.
- Treatment - The treatment plan or the set of services that are set to be commenced, along with their frequency and expected outcomes.
- Progress Notes - These are notes that are most relevant to mental health services, recording the progress that has been made over the various sessions.
- Medication Management - This document should record the medications that have been prescribed, along with their dosage, and any side effects, or adverse reactions owing to the same.
Conclusion
In this article, we’ve covered a brief primer of medical billing and coding systems, particularly in mental healthcare services.
In reality, this is a fairly complex system, requiring extensive documentation, records, and administration, something that requires an extensive system for processing, invoicing and coding, along with tools and specialized training programs for professionals involved in this field.
