Welcome 2019 IBH Expansion Practices 2019 QUARTERLY ADULT IBH MEETING 5-8-2019 1
Agenda Topic Duration Presenter(s) Introductions & Review of Agenda 5 minutes Rena Sheehan Practices Report Out: 1st 3 months of progress (& challenges) 45 minutes Review of Billing / Coding Document 20 minutes Review of Sample Adult & Pediatric Schedules with 10-minute Review of IBH Financial Model discussion Dr Nelly Burdette Next Steps 10 minutes Susanne Campbell 2
BEHAVIORAL Practice Report Out: IBH Baseline Screening Results Substance Use Practice Name Depression Anxiety Disorder Blackstone Valley Community Health Care 94.9% 1.5% 6.6% PCHC Crossroads 97.6% 16.9% 3.4% PCHC Central 96.4% 96.1% 95.7% PCHC Randall Square 93.1% 93.6% 92.5% Prospect Charter Care Physicians 84.0% 7.5% 0.1% Women's Medicine Collaborative 92.4% 96.7% 96.9% Coastal Edgewood 85.4% 1.0% 0.0% Tri County - North Providence 88.8% 88.9% 85.5% Brown Medicine - Warwick Primary Care 93.7% 85.2% 84.8% 3
Billing & Coding Behavioral Health Clinician in Primary Care Billing & Coding Guidance (Revised from ORBH@healthinsight.org) Page 1 Diagnostic Evaluation Code Service Description Required Permissible Tips/Guidelines NHPRI/Optu United/Optu BCBSRI Tufts Medicare Documentation Diagnoses m m Commercial 90791 Psychiatric Visit with intention of The assessment Psychiatric A psychiatric diagnostic evaluation is an Yes Yes Yes Yes Yes diagnostic doing a diagnostic concludes with diagnoses integrated assessment that includes history, (Special Note for Pedi: evaluation assessment, diagnostic documentation of a mental status and recommendations. It may BCBSRI recognizes (without clarification, or a diagnosis, rationale include communicating with the family and that the eval of Medical biopsychosocial for the diagnosis, and ordering further diagnostic studies. If a child/adol often takes Service) assessment a written treatment person is not in need of mental health longer than adults or disposition plan services, other disposition information, such and requires add'l supported by the as to whom the client was referred, shall be collateral contacts assessment and included in the client file. that further interview data NOTE: 90792 is the code for Psychiatrist differentiate this and includes evaluation for medication. population. BCBSRI NOTE: Generally this code cannot be billed allows providers to the same day as a psychotherapy code. file with a modifier Medicare allows one 90791 every 6 months “TU” for extended per episode of care, but 2nd evaluation 90791-psychiatric dx within a year requires documentation of eval > 75 minutes. medical necessity. NOTE: This code is rarely used in IBH as it requires more time and more documentation than is typical for an IBH assessment. Do not use this code unless you are sure you have a way to document this information in the EHR and have considered the implications of having all of this information in the EHR. NOTE: Although this is not a time-based code, an evaluation of this kind generally requires at least 45 minutes. 4
Billing & Coding Behavioral Health Clinician in Primary Care Billing & Coding Guidance (Revised from ORBH@healthinsight.org) Page 2 Psychotherapy (Time-based codes) Code Service Time/ Unit Description Required Permissible Tips/Guidelines NHPRI/ United/ BCBSRI Tufts Commercial Medicare Documentation Diagnoses Optum Optum Individual 30 minutes (16- Individual Documentation Psychiatric/ Note separate codes Yes Yes Yes Yes, but Tufts Yes Psychotherapy 37) psychotherapy, for all time-based mental health for family or group requires 90832 face-to-face codes must diagnosis therapy. In IBH, the "notification" with patient; include start & 90832 code will likely when any of 45 minutes (38- insight stop times (or be the one used most psychotherapy 52) oriented, duration) of often. services are 90834 behavior session; should provided, within modifying, highlight 30 days of first supportive, diagnosis, visit; 8 visits are and/or symptoms, available until the 60 minutes (> Optum requires interactive functional status, next 53) preauthorization of this psychotherapy. MSE where "notification" is code 90837 relevant, required; this is treatment plan not an and progress. authorization per se because svcs Family Psychotherapy N/A With Use for parent training Yes Yes cannot be denied, without patient family/without sessions if child is not but if the 90846 present patient present present notification isn't submitted, claims Family N/A With family Documentation Use for parent training could be denied Psychotherapy and patient should identify sessions if child is present why family present, or other 90847 therapy is family treatment indicated. services Developed by the Care Transformation Collaborative (CTC) 2019 5
Billing & Coding Behavioral Health Clinician in Primary Care Billing & Coding Guidance (Revised from ORBH@healthinsight.org) Page 3 Psychotherapy cont. Code Service Time/ Description Required Documentation Permissibl Tips/Guidelines NHPRI/Optum United/Optum BCBSRI Tufts Medicare Unit e Diagnosis Commercial Psychotherapeutic interventions of Documentation should Psychiatric Focus of group psychotherapy is Yes Yes Yes Yes, but see Yes several patients in one session. The include a description of the / mental to assist patient with his/her note on group may consist of patients with therapeutic intervention health psychiatric condition. Medicare previous page different diagnosis but share used to alleviate emotional, diagnoses sets limit of 10 participants; not similar facets of maladaptive behavioral or other sure of other insurers. This code emotional or behavioral 90853 Group Intervention N/A disturbance. Service must can be used in primary care for functioning. address treatment goals. group treatment as long as there Group therapy needs to be is a mental health component, listed as an intervention in and not just an educational the individual service plan, component; there must be a and why it is indicated rather licensed BHC running the group. Group therapy sessions for than individual therapy. This code could be used in multiple families when pediatric care - e.g. for an ADHD similar familial dynamics are group that includes families occurring due to a (parents and children). Multiple family 90849 group psychotherapyN/A commonality of problems in the family member under treatment Psychotherapy for Crisis (Time-based codes) Code Service Time/ Description Required Documentation Permissibl Tips/Guidelines NHPRI/Optum United/Optum BCBSRI Tufts Medicare Unit e Commercial Diagnoses 90839 First Used when psychotherapy Documentation highlights immediate Psychiatric These codes are reported by Yes Yes Yes Yes Yes emergency requiring crisis response, 30-74 services are provided to a / mental themselves - do not use with assessment of danger to self or others, minutes patient who presents in high health evaluation or psychotherapy interventions utilized, safety plan distress with complex or life- diagnosis codes development, Psychotherapy for 90840 + 30 threatening circumstances This code is used for each recommendations, referrals and follow crisis minutes that require urgent or 30-minute unit after the up plans immediate attention initial 74 minutes. If service is under 30 minutes use 90832. Developed by the Care Transformation Collaborative (CTC) 2019 6
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