health cpt code for hoosier healthwise healthy …...2012 cpt code definition 2013 cpt code 90791 +...

Behavioral Health CPT Code Changes for 2013 Hoosier HealthWise / Healthy Indiana Plan

Behavioral HealthServing Hoosier Healthwise and Healthy

Indiana Plan

MDWiseMDWise

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Behavioral Health CPT Code ChangesBehavioral Health CPT Code Changes

• Effective 1/1/13 The Centers for Medicare and Medicaid Services (CMS) accepted the proposed changes in behavioral h lth d did th t t f I di (IHCP B ll tihealth codes as did the state of Indiana (IHCP Bulletin BT201253)

• Professional organizations participate in the CPT process and are a good source of independent information about code use

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• The changes include the use of Evaluation and Management g g(E&M) Codes as well as add‐ on codes to reflect the length and complexity of the interaction

• The use of E&M codes ensures that certain aspects of the patient’s health are monitored and documented given that p gmany psychiatric medications can effect weight, blood sugars, etc.

• Only medical personnel with the ability to prescribe medications may use the E&M codes with add –on codesmedications may use the E&M codes with add on codes

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• It is important to carefully review the E&M codes to understand the time and intensity associated with each outpatient visit code

• The E&M codes are now intended to replace the previous CPT Codes that included medical management and evaluation (CPT Codes 90805 90807 90809 90811 90813 and 90862)(CPT Codes 90805, 90807, 90809, 90811, 90813 and 90862)

• The MCE’s expect minimal use of the interactive complexity add‐on code (CPT Code 90785)– The interactive complexity add‐on code replaces CPT Codes which were not often usedCodes which were not often used

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Examples of the use of Interactive Complexity Add‐On Code p p y(CPT Code 90785)

• Involvement of other individuals (parent, guardian) who are l ll ibl flegally responsible for care

• Involvement of other individuals such as interpreters, etc.

• Involvement of third parties such as schools parole/Involvement of third parties such as schools, parole/ probation officers, child welfare, etc.;

• The patient has impaired language skills such as aphasia.

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Behavioral Health CPT Add‐On CodesBehavioral Health CPT Add On Codes

Add‐on codes: Add‐on codes will deny if not filed with the correct respective codes

CPT Code 90785 • May only be used when very specific communication factors complicate the

delivery of psychotherapy• May only be used with the following CPT codes

– Diagnostic evaluation codes: 90791 and 90792– Hospital Psychotherapy codes: 90832, 90834, and 90837– Psychotherapy when performed with an evaluation and management (E&M)Psychotherapy when performed with an evaluation and management (E&M)

service: CPT codes 90833, 90836, 90838, 99201‐99255, 99304‐99337, and 99341‐99350

– Group psychotherapy: CPT code 90853

CPT Code 90833• 30 minute psychotherapy add‐on code (16‐37 minutes)• May only be used with Evaluation and Management Codes (Medication

Management)Management)• May only be used by medical professionals with prescriptive authority

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Behavioral Health CPT Add‐On CodesBehavioral Health CPT Add On CodesCPT Code 90836• 45 minute psychotherapy add‐on code (38‐52 minutes) p y py ( )• May only be used with Evaluation and Management Codes

(Medication Management)• May only be used by medical professionals with prescriptive authority

CPT Code 90838• 60 minute psychotherapy add‐on code (53 minutes or more)• May only be used with Evaluation and Management Codes

(Medication Management)• May only be used by medical professionals with prescriptive authority

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Behavioral Health CPT Codes Not Linked to & dE&M Codes

2013 CPT Code Definition

90791 + 90785 (Interactive complexity add‐on) PSYCHIATRIC DIAGNOSTIC EVALUATION

90792 + 90785 (Interactive complexity add‐on)PSYCHIATRIC DIAGNOTSTIC EVALUATION WITH MEDICAL SERVICES

90832 INDIVIDUAL PSYCHOTHERAPY 30 MINUTES

90834 INDIVIDUAL PSYCHOTHERAPY 45 MINUTES 90837* Anthem / MDWise require authorization unless otherwise noted in PPT INDIVIDUAL PSYCHOTHERAPY 60 MINUTES

90832 + 90785 (Interactive complexity add‐on) INDIVIDUAL PSYCHOTHERAPY INTERACTIVE, 30 MINUTES

90834 + 90785 (Interactive complexity add‐on) INDIVIDUAL PSYCHOTHERAPY INTERACTIVE, 45 MINUTES

90846 FAMILY MEDICAL PSYCHOTHERAPY90846 FAMILY MEDICAL PSYCHOTHERAPY

90847 FAMILY MEDICAL PSYCHOTHERAPY (CONJOINT)

90853 GROUP PSYCHOTHERAPY

90853 + 90785 (Interactive complexity add‐on) INTERACTIVE GROUP PSYCHOTHERAPY

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Behavioral Health i lkCommon Outpatient CPT Crosswalk

2012 CPT Code Definition 2013 CPT Code

90791 + 90785 (Interactive l dd )90801 PSYCHIATRIC DIAGNOSTIC EVALUATION complexity add‐on)

90802PSYCHIATRIC DIAGNOTSTIC EVALUATION WITH MEDICAL SERVICES

90792 + 90785 (Interactive complexity add‐on)

90804 INDIVIDUAL PSYCHOTHERAPY 30 MINUTES 90832

INDIVIDUAL PSYCHOTHERAPY 30 MINUTES E&M + 90833 (30 i t90805

INDIVIDUAL PSYCHOTHERAPY 30 MINUTES WITH MED EVALUATION

E&M + 90833 (30 minute psychotherapy add‐on)

90806 INDIVIDUAL PSYCHOTHERAPY 45 MINUTES 9083490806 INDIVIDUAL PSYCHOTHERAPY 45 MINUTES 90834

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2012 CPT C d D fi iti 2013 CPT C d2012 CPT Code Definition 2013 CPT Code

90807INDIVIDUAL PSYCHOTHERAPY 45 MINUTES WITH MED EVAL

E&M + 90836 (45 minute psychotherapy add‐on)

90808 INDIVIDUAL PSYCHOTHERAPY 60 MINUTES 9083790808 INDIVIDUAL PSYCHOTHERAPY 60 MINUTES 90837

90810INDIVIDUAL PSYCHOTHERAPY INTERACTIVE, 30 MINUTES

90832 + 90785 (Interactive complexity add‐on)

INDIVIDUAL PSYCHOTHERAPY 30 MINUTESE&M + 90833 (30 minute

h th dd ) d 9078590811

INDIVIDUAL PSYCHOTHERAPY 30 MINUTES WITH MED EVAL

psychotherapy add‐on) and 90785 (Interactive complexity add‐on)

90812INDIVIDUAL PSYCHOTHERAPY INTERACTIVE, 45 MINUTES

90834 + 90785 (Interactive complexity add‐on)E&M 90836 (45 i t

90813INDIVIDUAL PSYCHOTHERAPY 45 MINUTES WITH MED EVAL

E&M + 90836 (45 minute psychotherapy add‐on) and 90785(Interactive complexity add‐on)

90846 FAMILY MEDICAL PSYCHOTHERAPY 90846

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2012 CPT C d D fi iti 2013 CPT C d2012 CPT Code Definition 2013 CPT Code

90847 FAMILY MEDICAL PSYCHOTHERAPY (CONJOINT) 90847

90853 GROUP PSYCHOTHERAPY 9085390853 GROUP PSYCHOTHERAPY 90853

90857 INTERACTIVE GROUP PSYCHOTHERAPY90853 + 90785 (Interactive complexity add‐on)

90862 PHARMACOLOGIC MANAGEMENT (BRIEF) E&M90862 PHARMACOLOGIC MANAGEMENT (BRIEF) E&M

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Outpatient Evaluation and Management p gCodes

Evaluation and Management OP Codes DefinitionEvaluation and Management OP Codes Definition

99201‐99205 Office or Other Outpatient Services, New Patient

99211‐99215Office or Other Outpatient Services, Established Patient

99241‐99245Office or Other Outpatient Consultations, New or Established Patient

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Anthem Authorization Processes

Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies Inc The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and

Serving Hoosier Healthwise and Healthy Indiana Plan

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ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

INW3673‐PP 02/2013

Behavioral Health CPT Add‐On CodesBehavioral Health CPT Add On Codes

Anthem:

• Participating providers do not require prior‐authorization for E&M services (99201‐99205 and 99211‐99215) with dd d 90833 90836add‐on codes 90833 or 90836

• Participating providers are allowed 12 90838 add‐on codes per year without authorizationcodes per year without authorization

• Participating providers do not require authorization for Crisis Intervention Codes 90839 and 90840

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Anthem Prior‐AuthorizationBehavioral Health Data Sharing Form

• Anthem requires notification via the Behavioral Health Data qSharing Form within 5 business days of the diagnostic interview (CPT Codes 90791 and 90792)

U i t f th B h i l H lth D t Sh i F• Upon receipt of the Behavioral Health Data Sharing Form an authorization will be issued for 12 sessions (in addition to 90791 / 90792)

• The CPT Codes which are included in the 12 session authorization are the “bucket codes”

S i id h “b k d ” i CPT ifi• Services outside the “bucket codes” require CPT specific authorization

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Anthem Bucket CodesAnthem Bucket Codes


90832 INDIVIDUAL PSYCHOTHERAPY 30 MINUTES90832 INDIVIDUAL PSYCHOTHERAPY 30 MINUTES

90834 INDIVIDUAL PSYCHOTHERAPY 45 MINUTES

E&M + 90836 (45 minute psychotherapy add‐on)INDIVIDUAL PSYCHOTHERAPY 45 MINUTES WITH MED EVAL

90832 + 90785 (Interactive complexity add‐on)INDIVIDUAL PSYCHOTHERAPY INTERACTIVE, 30 MINUTES

E&M + 90833 (30 minute psychotherapy add‐on) INDIVIDUAL PSYCHOTHERAPY 30 MINUTES WITH and 90785 (Interactive complexity add‐on) MED EVAL

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Anthem Bucket CodesAnthem Bucket Codes


90834 + 90785 (Interactive complexity add‐on)INDIVIDUAL PSYCHOTHERAPY INTERACTIVE, 45 MINUTES

E&M + 90836 (45 minute psychotherapy add‐on) and 90785(Interactive complexity add‐on)

INDIVIDUAL PSYCHOTHERAPY 45 MINUTES WITH MED EVAL

90846 FAMILY MEDICAL PSYCHOTHERAPY

90847 FAMILY MEDICAL PSYCHOTHERAPY (CONJOINT)

90853 GROUP PSYCHOTHERAPY

90853 + 90785 (Interactive complexity add on) INTERACTIVE GROUP PSYCHOTHERAPY90853 + 90785 (Interactive complexity add‐on) INTERACTIVE GROUP PSYCHOTHERAPY

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Anthem Prior‐AuthorizationOutpatient Treatment Request Forms (OTR)

• Authorization for services beyond the 12th session may be obtained via the submission of the OTR

S ifi CPT C d h i i i i d if i• Specific CPT Code authorization is not required if services requested are in the “bucket list”

• If services requested are outside of the “bucket list” then• If services requested are outside of the bucket list then the specific codes requested should be included on the OTR

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CENPATICO AUTHORIZATION PROCESSES

• Cenpatico did not change the authorization requirements for p g qthe 2013 code changes.

• Participating providers are entitled to the initial assessment (90791 or 90792) and 5 therapy services without requiring authorization. Those new codes are 90832, 90834, 90837. , ,Once used, additional services will require authorization using an Outpatient Treatment Request Form (OTR).

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• As a reminder, Cenpatico will allow 2 services of , pdifferent treatment types on the same date of service (e.g.: 90834 and 90847) Each treatment type will be applied to an authorization separately. pp p y

• Cenpatico will not require authorization of the new crisis codes of 90839 or 90840 These codes willcrisis codes of 90839 or 90840. These codes will replace 99058 previously used for emergency service.

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• No authorization will be required for Medication Management by a psychiatrist or participating NurseManagement by a psychiatrist or participating Nurse Practitioner up to a maximum of 20 services per rolling calendar year.

• 99354 – 99357 are add‐on codes which replaced 90809 and 90815 These codes require authorization as they have in90815. These codes require authorization as they have in the past.

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1st Quarter MDwise Behavioral Health Updates

20132013

MDwise Behavioral Health 2013 Updates

• Indiana Health Coverage Programs (IHCP) reviewed the 2013


• Indiana Health Coverage Programs (IHCP) reviewed the 2013 annual Healthcare Common Procedure Coding System (HCPCS) code updates and announced coverage and billing guidelines to providers in BT20153 dated December 18, 2012.

whw1

whw1 Should it not be BT201253william h woodruff, 2/26/2013


P hi t i Di ti I t i


Psychiatric Diagnostic Interview

• CPT code 90791 or 90792 (Interactive Interview)

• 1 Unit per member, per billing provider, per rolling 12 th ll d ith PA 2 it ll d12‐months allowed with no PA. 2 units are allowed without PA when member is separately evaluated both by a physician an advanced practice nurse orboth by a physician, an advanced practice nurse or HSPP and another mid‐level practitioner.


I iti l 12 Th Vi it billi id PA l


Initial 12 Therapy Visits per billing provider PA rule:• CPT code: • 90832 Psychotherapy Office 30 min90832 Psychotherapy Office 30 min• 90834 Psychotherapy Office 45 min• 90846 Family medical psychotherapy• 90847 Family Psychotherapy conjoint

Group Therapy Visits included in 12 initial visits but notGroup Therapy Visits included in 12 initial visits but not interchangeable:

• 90853 Group Psychotherapy


• After the initial diagnostic interview (90791 or 90792),


e e a d ag os c e e (90 9 o 90 9 ),member can receive up to twelve (12) therapy sessions without PA per billing provider. Individual and Family h i b d i h bl h ftherapy sessions can be used interchangeably, therefore authorization applies to this group of codes.

• Group sessions can be provided as part of the initial 12 sessions without PA, however PA for group sessions are , g pnot interchangeable with individual and family therapy sessions and must be specifically requested.


19 Medication Management visit per billing provider PA rule


• 99201‐99203, New patient, office

• 99211‐99213, Existing patient, office

• 99241‐99242, Consultation, office

• After the initial diagnostic interview (90791 or 90792), PA is not required for the first 19 visits per billing provider for this group of codes. (Service provided by a psychiatrist or nurse practitioners/clinical nurse specialists who have prescription authority ) All other therapy visits for these codes beyond initial 19 require PA Seeauthority.) All other therapy visits for these codes beyond initial 19 require PA. See NOTE below for authorization application guideline.

• 90833 Individual Psychotherapy with medical E/M 30min and 90836 Individual Psychotherapy with medical E/M 45 min may be reimbursed in conjunction with y py / y jthese E/M codes and do not require a separate authorization.

• Interactive Complexity (CPT code 90785) is an add‐on code to this CPT group and does not require a separate authorization.


Extended therapy visits:


Extended therapy visits:

• 90837 60 minute code that replaces 90808 will not be• 90837 – 60 minute code that replaces 90808 will not be interchangeable as it also will need a separate PA.

Requires Prior Authorization


• Crisis Codes – No Prior Authorization Required


• 90839 ‐ Psychotherapy for Crisis first 60 minutes

• 90840‐ Psychotherapy for Crisis; each additional 30 minutes

• One unit of service may be reimbursed per dayOne unit of service may be reimbursed per day.

• Providers who spend less than 30 minutes total rendering psychotherapy of crisis must bill using CPT code 90832 or 90833.

• 90839 & 90840 may not be billed in conjunction with CPT codes 90791 or• 90839 & 90840 may not be billed in conjunction with CPT codes 90791 or 90792, or psychotherapy codes 90832‐90838.

• CPT code 90840 is an add‐on to 90839 and may not be used as a stand‐alone code 90840 is used to report additional 30 minute blocks of timealone code. 90840 is used to report additional 30‐minute blocks of time beyond the first 60 minutes of psychotherapy for crisis.

health cpt code for hoosier healthwise healthy …...2012 cpt code definition 2013 cpt code 90791 +...

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