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Outpatient Behavioral Health - Case Consultations

Justin Posted Tue 19th of May, 2020 19:12:14 PM
Hello - our facility provides outpatient behavioral health services for children, and one of our more common services is a multidisciplinary evaluation that may include psychiatric evaluation, neuropsychological/psychological testing, speech and language evaluation, and occupational therapy evaluation. One of our most common services provided is a case consultation service. Case consultations are team meetings where clinicians share testing results/observations, data and observations are then compiled to come up with clinical case formulation and treatment planning, and data that which is shared is informing interpretations of other clinicians' data and thereby impacts decision making and treatment planning. Within the context of a multidisciplinary evaluation, we're not sure if this applies to codes 96130/96132 or something else, and what the coding would be for speech/language and occupational therapy (do they fall as part of the evaluation codes, or are they unlisted codes 92700/97799?). Outside of the context of a multidisciplinary evaluation, when two providers or more are performing a case consultation between one another for continuity of care and treatment planning, does that change what the coding would be for such a service? It's common that a client of ours would see multiple providers, where brief case management or consultation affects treatment planning. Please note that the question does not apply to psychiatrists/nurse practitioners, whom we have a firm understanding of how they would code for this. Thank you!
SuperCoder Answered Wed 20th of May, 2020 10:56:05 AM

Hi Justin,

In the CPT code 96130, the provider, physician or other qualified healthcare professional, administers standardized psychological tests to a patient, interprets the results, establishes a treatment plan, and prepares a report. This code covers the first hour of this service and includes discussion of results and treatment plan with the patient and family member(s) or caregiver(s), when performed. Whereas, in CPT 96132, the provider, a physician or other qualified healthcare professional, spends up to one hour administering neuropsychological tests, which includes time spent face–to–face with the patient in performing the tests, interpretation of the outcome, and preparation of the report. The code includes time spent in discussion of the outcome with the patient and family members or caregivers.

In these kind of services, clinicians share testing results/observations, data and observations, compilation, treatment planning, interpretations of other clinicians' data will not billed separately, as performing the tests, interpretation of the outcome, and preparation of the report is the part of evaluation service. And, it is good if you are discussing patient's reports and getting interpretation from other clinicians' notes, so it will positively impacts medical decision making (MDM) by adding the points of "Review and summarization of old records and/or obtaining history from someone other than patient and/or discussion of case with another health care provider" under MDM.

On the other hand, speech/language and occupational therapy can be billed separately performed when performed. CPT 92507 can be billed for Treatment of speech, language, voice, communication, and/or auditory processing disorder for individual and CPT 92508 for group, 2 or more individuals.

For Occupational Therapy Evaluations code range 97165-97168 can be billed according to the documentation.

Also, when two providers or more are performing a case consultation between one another for continuity of care and treatment planning, it can be coded through the Office or Outpatient Consultation Services (99241-99245), when there is requirement of consultation. To substantiate a consultation service, documentation must include three elements: a request, a reason, and a report. An equally crucial fourth factor is intent. Or providers can bill only for the part of services they are performing.

Hope this helps!

Justin Posted Wed 20th of May, 2020 11:47:31 AM
Just a brief follow-up - it's my understanding that 99241-99245 would be E&M codes, therefor only available to our psychiatrists and nurse practitioners to use and not psychologists, marriage/family therapists, speech and language pathologists, or occupational therapists correct? If that's the case, then is this continuity of care and treatment covered under any code respectively if they cannot use 99241-99245? Many, many thanks.
SuperCoder Answered Thu 21st of May, 2020 08:48:57 AM

Hi Justin,

Hope you are keeping well.

Yes, you are right, consultation codes (99241-99245) are E&M codes, these can be billed only to the provider who can performed 3 key components of the codes, i.e. History, Examination and Medical Decision Making (MDM). Whereas, speech and language pathologists or occupational therapists have their own specialty evaluation codes, so they need not to bill E&M code series. Also, continuation of care will be the part of their service, they can bill it with the service codes they are performing.

92507 and 92508 are special codes that are not included in an evaluation and management service. Speech–language pathology services are necessary for the diagnosis and treatment of speech–language disorders that result in communication disabilities. 92507 and 92508 are not the time–based codes. Therefore, it is incorrect to bill multiple units on the same day, regardless of the time spent with the patient. Also, check your payer guidelines, because local Medicare carriers specify varying guidelines, but many require that ongoing speech therapy services be provided by a speech–language pathologist (SLP). For Occupational Therapy, as mentioned earlier, code series 97165-97168 can be used for evaluation. If they are using the Rehabilitation Modalities then code range 97010-97028 and for Therapeutic Procedures code 97110-97546 can be used, as per service provided and your documentation basis.

Hope this helps!

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