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S9485 Crisis intervention mental health services, per diem

Kelly Posted Wed 27th of March, 2019 09:14:42 AM
When is it appropriate to report S9485 for behavioral health services with the CPT codes, shown below? There are no CCI edits for the S9485 when billed with each code below, I am just trying to make sure it is okay to bill these together and when. INTERACTIVE COMPLEXITY, ADD-ON (90785) 90785 DIAGNOSTIC ASSESSMENT (90791) 90791 PSYCHOTHERAPY 16-37 MIN W/PATIENT (90832) 90832 PSYCHOTHERAPY 38-52 MIN, W/PATIENT (90834) 90834 PSYCHOTHERAPY 53+ MIN, W/PATIENT (90837) 90837 PSYCHOTHERAPY FOR CRISIS, FIRST 60 MIN 90839 PSYCHOTHERAPY FOR CRISIS, EA ADD'L 30 MIN 90840 FAMILY THERAPY W/O PATIENT, 26+ MIN (90846) 90846 FAMILY THERAPY W/PATIENT, 26+ MIN (90847) 90847 MULTI-FAMILY GROUP THERAPY(90849) 90849 GROUP THERAPY (PATIENT GROUPS) (90853) 90853 PROLONGED SERVICE, FIRST HOUR (99354) 99354 PROLONGED SERVICE, EA ADD'L 30 MIN (99355) 99355 CPST (FACE-TO-FACE) PER 15 MIN H0036 CRISIS SUPPORT, PER 15 MIN (88) Z1685 PER DIEM Z3002
SuperCoder Answered Thu 28th of March, 2019 09:38:27 AM

Hi Kelly,

The above presented documentation seems a bit confusing. As far as code S9485 is concerned,

Emergency Services program (ESP) provides crisis assessment, intervention, and stabilization services 24 hours per day, seven days a week, and 365 days per year to individuals of all ages who are experiencing a behavioral health crisis.

Use this code for Stabilization Services provided in a facility licensed by Department of Health and certified by DBHR as either Crisis Stabilization Units or Crisis Triage Facilities.

A client may be admitted and discharged within the same day.

Also, do not report 90839, 90840 in conjunction with 90791, psychotherapy codes 90832 through 90836, or other psychiatric services. Only use 90840 in conjunction with 90839.  Feel free to ask for any further query.

https://www.mass.gov/files/documents/2017/10/03/sub6-mhc.pdf 

Kelly Posted Thu 28th of March, 2019 10:12:19 AM
Sorry about that-I was trying to be helpful and provide all of the CPT codes ;-) Can the S code be charged with all of the other codes as appropriate? For example: If documentation supports the services to be charged, can we report: S9485 with 90839, or S9485 with 90791, or S9485 with 90832, as long as the S code is reported only one time per day?
SuperCoder Answered Fri 29th of March, 2019 04:40:00 AM

Hi Kelly,

Since it is a little tough one, and there are no direct links to support these services, so before we go ahead, we need to understand the difference between crisis intervention and stabilization.

Crisis intervention refers to offer immediate, short-term help to individuals, to stabilize the person's mental state and prevent immediate harm to the person or others in contact with that person. Whereas, stabilization is a long-term help (for all age group) to patients, with medication, therapies like alleviation of any emotional disruptions, personality growth and development through coping techniques.

Note: If the patient has an existing provider and treatment plan, and the Crisis Stabilization provider is comfortable working with the existing plan, then an individual in on-going treatment may continue to see that Crisis Stabilization provider. However, if existing treatment plan is not sufficient and emergency is experienced by the child/adolescent and needs immediate Emergency Services program (ESP), same provider cannot bill for the crisis intervention code or other behavioral health services on the same date of services.  

So, we will not bill S9485 with 90839, or S9485 with 90791, or S9485 with 90832 on the Same DOS by the same provider. Also, S9485 is not payable by Medicare. We must also check with payer policy before billing these codes. Hope it helps.

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