by Government Relations Staff
May 10, 2005 -- Where can I find the ICD-9-CM diagnosis code that corresponds to a particular DSM-IV code? When should I use the health and behavior assessment/intervention CPT® codes? Read on for answers to these and other questions that practitioners often raise with staff for the APA Practice Organization.
Q: I understand that health insurers are moving from DSM-IV to ICD-9-CM diagnosis coding. Where can I find the ICD-9-CM code that corresponds to a particular DSM-IV code?
A: Under the Health Insurance Portability and Accountability Act (HIPAA), insurance companies that accept and process insurance claims electronically are only required to accept ICD-9-CM diagnosis codes. There is no HIPAA requirement that insurance companies also accept DSM-IV codes.
The APA Practice Organization has a document that provides a “crosswalk” to help you determine which ICD-9-CM code corresponds to a particular DSM-IV code.
Q: Where can I get the CPT codes for psychological services?
A: The CPT coding system is a copyrighted product of the American Medical Association. The CPT Manual containing a complete list of the codes and their descriptors is available for purchase from the AMA online at https://www.ama-assn.org/opens in new window or by calling 800-621-8335.
Q: A candidate for gastric bypass surgery has been referred to me for an assessment. How do I code that, and will I get paid for doing the assessment?
A: Health and behavior assessment/intervention CPT codes can be used to capture psychological services that treat behavioral, social, and psychophysiological conditions for the treatment or management of physical health problems. Services under these codes address an assortment of physical health issues, including adherence to medical treatment, symptom management, health promoting behaviors, health-related risk taking behaviors, and overall adjustment to physical illness.
In providing a pre-surgical assessment of a candidate for gastric bypass surgery, select the appropriate health and behavior assessment CPT code for evaluating the patient depending on whether it is an initial evaluation (code 96150) or a reassessment (code 96151).
However, be aware that many insurance companies will not pay for gastric bypass surgery and services related to the procedure. Before meeting with the patient, it is best to check with a patient’s insurance company about whether or not this service will be covered.
Q: Where can I find more information about the health and behavior assessment/intervention CPT codes?
A: See the question-and-answer guide about these codes.
Q. I practice in a rural area and would like to reach more patients in my state by using interactive technology. I see that Medicare includes individual psychotherapy on its list of telehealth services. Will I need to use special codes to bill for services offered through telehealth?
A: You should bill using the same CPT codes that you would use for an outpatient visit, but will need to add a “GT” modifier to indicate that you provided a telehealth service. For more specific information, look on the website for your local Medicare carrier.
Q: If I see a patient for a 50-minute psychotherapy session and then spend 15 minutes writing up notes about that session, should I bill for those additional 15 minutes?
A: No. Reimbursement for psychotherapy (and also health and behavior assessment/intervention) services must be based on the amount of time that you spend face-to-face with the patient. Payment levels for these services are based on the assumption that some pre- and post-service work -- such as reviewing a patient’s record, report writing, and interpretation -- will be performed after the patient leaves. Even though a code only describes time spent with the patient, the reimbursement level takes into account other aspects of the service such as those listed above.
Q: In billing Medicare, can I use the psychotherapy codes that include evaluation and management services?
A: No. Psychologists are not permitted to bill Medicare using evaluation and management (E & M) services. The Centers for Medicare and Medicaid Services (CMS), which administers the Medicare program, considers an E & M service a medical visit that includes all of the following: a family medical history; history of present illness; medical management, past medical and social history and a review of medical systems such as cardiovascular, skin, musculoskeletal, and endocrine. As such, CMS restricts the use of E & M codes to physicians, and in some cases, nurse practitioners and physician assistants.
The APA Practice Organization has long advocated for CMS to allow psychologists to bill for E & M services. Yet the federal agency has held to its policy that since psychologists generally cannot perform all facets of E & M services, such as medical history taking and medication management, they may not bill using these codes.
A majority of private carriers follow Medicare’s guidelines in setting their own reimbursement policies, including having policies similar to Medicare’s that limit E & M code usage.
Current Procedural Terminology© 2005 American Medical Association. All Rights Reserved.