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Psyc Collab Care 99492 billed 2 days following Psych Therapy 90837

Rosa Posted Tue 09th of April, 2019 13:59:34 PM
Patient was seen on 12/4/18 for Psychotherapy at which time we billed 90837, 90785, and 96127. On 12/6/18 one of our Licensed Professional Counselors (LPC) billed 99492 for Initial Psychiatric Collaborative Care Management. We are receiving denials from BCBS stating 99492 is "Not eligible for separate reimbursement". Is this code being considered bundled with any of the Psychotherapy codes previously billed due to the date range?
SuperCoder Answered Wed 10th of April, 2019 07:57:19 AM

Thank you for your Question.

 

CPT codes 99492, 99493, 99494 are reportable by primary care for their collaboration with a qualified behavioral health provider, such as a Psychiatrist, Licensed Clinical Social Worker, etc. Care is directed by the primary care team and includes structured care management with regular assessments of clinical status using validated tools and modification of treatment as appropriate. The psychiatric consultant provides regular consultations to the primary care team to review the clinical status and care of patients and to make recommendations. These codes are intended to represent the care and management for patients with behavioral health conditions that often require extensive discussion, information-sharing, and planning between a primary care physician and a specialist.

 

The behavioral health care manager providing other services in the same calendar month, such as psychiatric evaluation (90791, 90792), psychotherapy (90832, 90833, 90834, 90836, 90837, 90838), psychotherapy for crisis (90839, 90840), family psychotherapy (90846, 90847), multiple family group psychotherapy (90849), group psychotherapy (90853), smoking and tobacco use cessation counseling (99406, 99407), and alcohol and/or substance abuse structured screening and brief intervention services (99408, 99409), may report these services separately. Activities for services reported separately are not included in the time applied to 99492, 99493, 99494.

 

Psychiatric collaborative care management services in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional (99492, 99493, 99494) are considered incidental to the evaluation and management service and are not eligible for separate reimbursement.

Note:

CPT codes 99492, 99493, and +99494 all specify that when reporting, you must make sure the psychiatric collaborative care management was performed "in consultation with a psychiatric consultant and directed by the treating physician." You will need to check for edits if you are planning on reporting this CCM code with any psychiatry code on same date of service. However, in many cases, it may be appropriate for a single practitioner to report the general BHI code or the CoCM codes for the same beneficiary over the course of several months. Please check with your payer for more specific guideline. Please find undermentioned links for more information.

 

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FQHCPPS/Downloads/FQHC-RHC-FAQs.pdf

 

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/Behavioral-Health-Integration-FAQs.pdf

 

Hope this Helps!

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