CPT Codes 99213 and 99214: Behavioral Assessment Billing

What are the codes, who can bill for them and what are the differences between the two?

 

Both of these CPT (Current Procedural Terminology) Codes are part of a particular family of billing codes, including 99211-99215. They are part of HCPS, the Healthcare Common Procedure Coding System. They are used for office visits with established patients being treated for medical and mental health conditions.

While these two codes are within the same family, they do have different regulations for reimbursement. Due to some of their similarities, many healthcare providers can experience confusion when deciding which one to bill.  The fact that one code provides for additional revenue/reimbursement makes it critically important to thoroughly understood the differences. This way, all clinicians billing with these codes can receive the highest reimbursement for their services.  This being said, providers must be sure that the treatment being offered accurately represents the services required for billing with such a code

Some providers bill with CPT Code 99214 all the time. Others are afraid that they won’t be reimbursed for it. Once you know the ins and outs of both codes, choosing which one to bill is actually quite simple. To avoid any pitfalls, let’s take a closer look at each code and how it can be used for reimbursement.

 

What exactly are CPT Codes 99213 and 99214?

CPT Code 99213 can be utilized for a mid-level outpatient or inpatient office visit. CPT Code 99213 is a level three code that should be used for an established patient. It cannot be used with a new patient who has no history. However, this code is extremely popular, being the second most used among middle level billing codes. This is due, in part, to more easily achieved factors for reimbursement on this code than with other CPT Codes, including 99214.

CPT Code 99214 can be used as part of the second highest level in care for a patient’s visit. CPT Code 99214 is a level four code that can be used only for an established patient, whether the visit is conducted in the office or in an outpatient atmosphere. Therefore, it is no surprise that CPT Code 99214 is used the most frequently for this form of visit. It offers higher revenue/reimbursement than some similar CPT codes, including CPT Code 99213. This has especially been the case since changes were made back in 2013,  along with the Affordable Care Act’s inclusion of mental healthcare in 2006.

 

Who can bill with CPT Codes 99213 and 99214?

Many medical professionals can bill with CPT Codes 99213 and 96214. The good news is that it is not only for mental health providers or therapists. Behavioral health assessments can be very important tools in the most common of healthcare environments. For example, they can be used in primary care or OB/GYN offices.

An easy-to-understand example of a physician using CPT Code 99213 is when an existing patient has a scheduled appointment for a routine health examination. This patient may have had mild back pain for three or four years, being treated with muscle relaxants. When the pain occurs, the patient may also experience anxiety, which is being treated with a low-dose anxiolytic medication. There are no new diagnosis or medications prescribed. However, behavioral assessment tools may be utilized to ensure that the anxiety is still at a mid-level, with no additional risk factors.

A great example of a primary care doctor using CPT Code 99214 is when an existing patient comes in for a routine health examination for chronic pain. However, the flow of conversation may quickly turn to feelings of depression that are now accompanying this pain. The physician may choose to prescribe a medication for the patient’s behavioral health ailment. In more severe cases, perhaps even a referral may be set in motion for a mental health professional. Standardized assessment tools for depression (e.g. PHQ-9) may also be used to gather more detailed information.

 

What procedures are there for billing CPT Code 99213?

Understanding the conditions that must be present for billing with CPT Code 99213 is pretty straightforward. There must be two out of three of the following components:

  • An expanded problem-focused history
  • An expanded problem-focused examination
  • Medical decision-making with low complexity

Any mix of these three components will enable a provider to bill with CPT Code 99213. However, there must be a sum of at least 15 minutes of face-to-face time with the patient. The problems are typically considered to be of low to moderate severity.

What procedures are there for billing CPT Code 99214?

This is actually the simplest part of billing with CPT Code 99214. There must be two out of three factors included for proper billing of Code 99214. These necessary components include:

  • A detailed interval history
  • A detailed examination
  • Medical decision-making that can be considered to be of moderate complexity

Any mixture of these components necessary to bill for CPT Code 99214 should be presented in face-to-face time with the patient, totaling 25 minutes. The problems are usually of a moderate to high complexity.

How Do You Meet These Components?

While the detailed or expanded exams are fairly commonplace, as well as easily achieved, most of the questions come in regarding the history and decision-making components. However, these may also be carried out and documented in far less complex methods than originally anticipated.

The detailed or expanded history can be simply derived from past charts of the existing patient. However, it can also be even more easily collected through assessments that are filled out in the waiting room. A good example of this is the utilization of mental health assessment tools to investigate the possibility of mental illness as a possible attributing factor to a health problem.

Also keep in mind that decision making does not always need to include detailed exams. It can most commonly be achieved when a consultation with a specialist (e.g. a psychologist or a psychiatrist) is required. With 99214 , it is possible when there has been a new diagnosis (e.g. depression or anxiety), requiring further testing or a new medication prescription.

 

How often can testing be billed with CPT Codes 99213 and 99214?

When it is discovered that a patient requires this low (CPT Code 99213) or moderate (CPT Code 99214) level of care during a visit, being able to bill for additional revenue is like a bonus, second to providing extended care for a patient in need. CPT Codes 99213 and 99214 may be billed in time-derived methods for each patient during each session where the guidelines for billing are met. Healthcare providers will be able to provide a higher level of care for their patients by discovering mental health issues. They will also be able to bill for these additional options.

 

How much are reimbursements for screenings billed using CPT Codes 99213 and 99214?

Billing with CPT Codes 99213 and 99214 are both based on face-to-face time during the visit. These visits will include any behavioral assessment tools that are utilized during the appointment. For example, a major national healthcare insurer’s policies include CPT Code 99213 being reimbursed for up to $72.70 for each patient. With the same insurer, CPT Code 99214 can be reimbursed for up to $107.20 for each patient.  That is a difference of nearly $35 per patient, which could mean a difference of literally hundreds of dollars each day or well over a thousand dollars each week.

 

Where can I find standardized screening instruments to use with CPT Codes 99213 or 99214 for behavioral assessments?

Mentegram has a library full of online tools, such as the PHQ-9, that range from detailed surveys to simple sliding scales. They can be used to increase the complexity of visits and thereby qualify for billing with a higher code (e.g. billing CPT Code 99214 instead of 99213). Mental healthcare providers may also use these tools to help reduce and even replace paperwork. This can save valuable time in patient intake and with screening the patients and monitoring their progression, even in between appointments.

 

What are the most important things to remember about differentiating between CPT Codes 99213 and 99214?

  1. Be sure to remember the difference in the components that must be present to bill for each code.
  2. Make sure that medical necessity is the driving factor to determine if low-level or moderate-level care is given.
  3. Ensure that your documentation also supports the level of care that is being billed.

 

Ask us how you can start billing with CPT Codes 99213 and 99214, as well as with other codes today!

 

For more information on other ways to bill and increase your practice’s revenue, check out our articles on CPT Code 96127 and CPT Code 96103:

CPT Code 96127 – Answers to the frequently asked questions about billing this code

3 Online Screenings That Can Be Billed with CPT Code 96127

CPT Code 96127 – How to Increase Revenue with This New Behavioral or Emotional Assessment

CPT Code 96103: How to Increase Revenue and Bill with Psychological Testing

DISCLAIMER: Please keep in mind that Mentegram is a healthcare technology company, and do not consider content on our website as legal advice. It is your responsibility to decide to act on this content, relinquishing Mentegram of all claims. The information that we share is based on what has been effective  for our customers and the best practices as published by authoritative sources.
For specifics regarding your individual practice and specific cases, please consult the particular insurance companies or your office’s billing consultant for additional information.

SOURCES:

http://thehappyhospitalist.blogspot.com/2013/09/99214-CPT-Procedure-Code-Description-Examples-RVU-Distribution.html

https://www.cgsmedicare.com/partb/mr/pdf/99214.pdf

http://bh.medicaid.ohio.gov/Portals/0/Users/008/08/8/Coding-Documentation-for-Behavioral-Health-2016-Zucker.pdf?ver=2016-06-01-182611-063

http://www.mdedge.com/jfponline/article/63368/practice-management/10-billing-coding-tips-boost-your-reimbursement

https://www.cgsmedicare.com/partb/mr/pdf/99213.pdf

http://www.hcca-info.org/Portals/0/PDFs/Resources/Conference_Handouts/Clinical_Practice_Compliance_Conference/2010/Sun/P3_BrembyFriedelPPT-PDF.pdf

https://emuniversity.com/Level3EstablishedOfficePatient.html

http://www.medicarepaymentandreimbursement.com/p/medicare-fee-schedule-for-office-visit.html

 

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5 Things Primary Care Physicians Need to Do to Set Up Successful Integrated Care

The topic of integrated care as a healthcare model for primary care physicians seems to come up more and more. Integrated care, also known as collaborative care, can best be described as the blending together of two types of care. These are primarily physical and mental healthcare. This worldwide reform offers new arrangements and forms of office organization. Patients will be able to expect a more complete experience, especially when mental healthcare options are not always readily available in their area.   

Primary care settings everywhere are implementing integrated health as the best possible scenario for seamless care. The end result is that this produces a solid, positive outcome.

However, there is a process involved to welcome in collaborative care. There are even some barriers to overcome so that this new model is successful in each ideal situation. Let’s take a look at five things that primary care physicians (PCPs) should do in order to streamline the introduction of this care into their offices.

 

1.) Seek Education on the Integration

Learning how to address mental health disorders is only the tip of the iceberg when it comes to introducing an integrated behavioral health practice into primary care. This is why programs are available, so that physicians, nurses and other office staff are brought up to speed on the objectives that must be met.  This educational effort ensures that they are equipped to manage an integrated practice.

 

2.) Set Aside Time in the Office Visit

Most primary care physicians have a routine with their patients during their scheduled office visits. However, if a good collaborative model is what the PCP is after, time constraints may need to be re-evaluated. To really go after successful patient outcomes, it is extremely important to allow for extra time.  This allowance will be dedicated to mental healthcare during examinations and consultations.

 

3.) Learn How to Ask the Hard Questions

Many primary care physicians are only used to asking exploratory questions like, “How are you feeling emotionally?” And unfortunately, a patient’s typical response is usually, “Fine”. This is mostly do, in part, to the stigma that is still associated with mental health disorders. However, when making strides toward integration, this interaction will need to be more than a casual question thrown in after “Are you still having those headaches?” Physicians will need to learn how to dig a little deeper, alert to signs that a mental health disorder may be present.

 

4.) Make Mental Health Screenings a Priority

When integrating a primary care office, nothing can be as important as utilizing the proper mental health screenings. Making use of digital tools, like the PHQ-9, will be imperative.  This will assist PCPs with finding the required answers to the right set of questions. Using software to screen patients will also cut down on the administrative time needed. Patients can easily fill out the surveys from their own smartphone. Some offices may even offer the convenience of a kiosk in the waiting room.

 

5.) Become Successful in Scheduling Outpatient Mental Health Services

A barrier that many primary care physicians run into is the lack of mental healthcare professionals in their areas. When it becomes fairly obvious that a patient requires a level of mental care that would not be available in a primary care setting, being able to make that referral should not stand in the way of what the patient needs. However, this is exactly why integrated healthcare is becoming so popular. It is often the only way to present mental health services to a patient in a particular area, without complete lack of access or a long waiting period. But it is also important to make sure that the PCP has resources available to provide outpatient options, should it be necessary. Online counseling services like BetterHelp may be a great way to start.  This will be especially helpful if you don’t already have a mental health professional in your practice.

 

Mentegram already has a few success stories with customers who are currently incorporating integrated care. Most are also introducing mental health screenings into their practices. My Doctor Medical Group is located in San Francisco, and they specialize in providing primary care.  They also offer addiction treatment, urgent calls and other services vital to a patient’s recovery. Dr. Jennifer Banta, the Director of Behavioral Health, states, “Our integrated medical practice has been using Mentegram for about a month, and I am very excited about the early results with this self-tracking tool in more fully engaging patients in their own treatment.” For even more details, read more about these screening tools and her success from our recent article with Dr. Banta.

The more common integrating behavioral health practices with primary care becomes, the instances in which a patient truly needs mental healthcare and does not have access to it will decrease. Plus, with software like Mentegram, the face of mental healthcare will forever change. Concerns about bridging the gap between mental healthcare and the patient’s continued interest in treatment will become a thing of the past. Won’t that be a fantastic day?

 

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How To: HIPAA Compliant Video Conferencing With Mentegram Notes

Online therapy and HIPAA compliant video conferencing is becoming a new standard in therapy. Of course, this does not replace face-to-face appointments. Instead, it provides a huge opportunity for people to receive care if they can’t make it to the therapist’s office. This also gives therapists the opportunity to gain even more clients.

Read more

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Psychiatry and Primary Care: More Closely Linked for the Future

Have you ever heard that old saying, “The more things change, the more they stay the same?” This definitely applies to the ever-fluctuating connection between psychiatry and primary care. As we see more and more therapy-related scenarios play out in primary care offices across the globe, there still seems to be a barrier.

Imagine a wide cavern, with therapists, psychiatrists and other mental healthcare professionals all on one side. On the other, envision physicians, nurses and administrative personnel who play numerous roles in ensuring that we all stay healthy. Yet, somewhere in the middle, wouldn’t it be fantastic if these two healthcare facets could assist one another? Could they achieve even more success in patient outcomes along the way?

At Mentegram, we can clearly see the type of bridge that needs to be built. Fortunately, more and more clinicians are realizing this as a reality in their own practices, as well. Yet, it is extremely exciting when major organizations not only recognize the changes that need to be made within the system, but they actively work to educate other professionals.

PsychU is a community that is made up of mental health professionals who are absolutely dedicated to the improvement of healthcare. In achieving this, they provide information, set up discussions and find innovative new ways for interested individuals to collaborate. In a recent webinar, they did just that.

Entitled “Bridging the Gap Between Primary Care & Psychiatry in the Treatment of MDD”, this webinar showcases three speakers (Venus Miller, MSN, ARNP, FNP-BC, PMHNP-BC, Roland Larkin, PhD, NP and Kimberly Lonergan, RN, MSN) who share their knowledge of the best ways to build a deeper connection between mental healthcare and primary care.

Even though many of us know the figures, sometimes seeing them filter across a presentation at a slideshow really sends the message home. Take a look at these percentages for illnesses that are accompanied by depression:

  • High blood pressure 24%  
  • Asthma 17%  
  • Diabetes 9%  
  • Heart Disease 7%  
  • Stroke 3%

On the other end of the spectrum, depression makes up 5 to 10% of the reasons people are seen at a primary care clinic. Yes, that’s right, seeing your PCP (primary care physician) is not just for flu symptoms or migraines! In fact, 79% of antidepressant medications are prescribed by a health professional, and 60% of people with depression are seen by a PCP.

The idea of seeing a primary care professional for mental health disorders will even be more successful depending upon the attitude of the physician and how the patient is responding to the care. However, there are a few things that are currently standing in the way of closing this gap.

 

Physicians

  • The attitude of the physician plays a key role in a successful outcome, especially how open they are to discussing mental health disorders. If a physician has a difficult time asking the hard questions, then the answers they receive will not paint a very clear picture.
  • The time that a physician has available for mental health issues will play a key role. If there’s only a moment for, “Hi, how are you feeling?”, then it will be extremely difficult to gather the information that is needed to set forth a treatment plan.
  • It is not only important to ask the right questions, but to document them in a way that saves everyone time, while still providing the patient a chance at the best care possible. The physicians must set a plan in motion that involves screening patients for mental health care problems, preferably with survey-style forms like the PHQ-9.

 

Patients

  • With patients, their failure to seek this kind of care normally pertains to the stigma that is often associated with reaching out for mental health assistance. It’s often an easier first step for the patient to ask their PCP a few questions about their anxiety, rather than sit down for a full session with a therapist.
  • Some patients have lack of access to such treatment. If it is not made available to them, then there can be absolutely no chance of a successful outcome.
  • The most difficult factor for some patients to overcome is their complete lack of awareness that there is a problem. Again, if they aren’t asked the questions, then they are never prompted to reflect upon their own mental health.

 

A survey shows that collaborative care within a primary care office works best when utilizing screening tools like the PHQ-9 and support provided by a care manager. When a patient has high blood pressure or heart disease, there are tests and tools used to gauge their responsiveness or the success of their treatment. It should be no different in mental healthcare, especially with the ability to use screening tools for depression and anxiety, like the PHQ-9.

Venus Miller, one of the webinar speakers, is a Family & Psychiatric Nurse Practitioner at SMC Medical Center in Miami and Infinite Behavioral Health in Hollywood, Florida. Her clinical areas of expertise include family and psychiatric medication assessment and treatment across the lifespan, as well as substance abuse disorders in dual diagnosis clients. Therefore, she is the perfect person to address the changes that could be coming down the pipeline in the mental healthcare industry.

Venus stated, “There’s no more time for not addressing this issue.” And she’s right. This is one of the most prolific statements made when looking at the urgency of bridging this gap between primary care providers and mental healthcare personnel.

As we strive toward a deeper connection between primary care and mental health, we must first look at what services are offered by the PCPs, and then decipher the best ways to conduct screenings to offer those services.

If you’re looking for  way for patients to be screened for mental healthcare disorders from the waiting room, with little or no administrative assistance, take a look at what Mentegram has to offer. Bridging this gap might not be as difficult as you might think.

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6 Steps for Writing Notes During Online Therapy

Therapy is rapidly changing and I think it is such a great thing. We can now offer clients flexibility and increased access to services through online therapy, surveys and outcome measures any time of day, and things like file sharing.

Things have changed a LOT in just the last 10 years. With this switch to increased use of technology, some therapists find it difficult to conceptualize how things may be different from paper. And nothing seems to be more difficult for therapists than maintaining notes.

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Mentegram in Primary Care: Our Customer Story

Mentegram has started reaching outside of the pure mental health settings. The first customer is My Doctor Medical Group, a medical practice from San Francisco. They specialize in providing primary care, as well as addiction treatment, urgent calls and other services vital to a patient’s recovery. Their doctors, led by Dr. Paul Abramson who is the Medical Director, are also available to provide visits at home, at hotels, on location or even at your office. We asked Dr. Jennifer Banta, the Director of Behavioral Health, to share a few words on how Mentegram is working for My Doctor Medical Group.

Dr. Jennifer BantaOur integrated medical practice has been using Mentegram for about a month, and I am very excited about the early results with this self-tracking tool in more fully engaging patients in their own treatment.

I have been a licensed psychologist for over a decade, and one of the biggest challenges in treatment is having patients continue to do the work of therapy when not in therapy. Follow-through on paper-and-pencil homework assignments tends to be inconsistent due to forgetting, misplacing assignments, and poor motivation. Workbooks are somewhat better at encouraging completion of work, however, they tend to be specific to one topic, and that is not ideal when we are treating complex cases that do not present only one problem.

Apps are also often specific to one problem (eg, weight loss), and I have found that the average patient has bandwidth for one or perhaps two apps at a time without fatiguing or burning out.

Mentegram has come along and provided a generous library of brief, patient-friendly interventions that span a broad range of common presenting problems across physical and emotional well-being. Moreover, we can create custom interventions tailored to our specific patients. We are finding our patients want to help design their intervention, adding affirmations to keep them focused, behavioral activation that is meaningful to them.

Research has shown us that ownership and engagement in a solution will lead to better outcomes, and our patients are now helping shape the solutions to their problems. I look forward to and fully expect that this will translate to improved treatment compliance, because our patients are now part of their treatment goals and design in an entirely new and empowered way.

Of 7 patients I had start tracking data on my caseload, 6 have tracked within the past week and 4 within the past 24 hours. I understand this is a small sample size, but it should also be meaningful to anyone who is in clinical practice. It is quite extraordinary, particularly given the rich significance and customization of the data we are collecting and using together with our patients to optimize their health and well-being.

I can’t say enough about the product support from Milan, the founder, and his team. Well done!

Seeing how Mentegram keeps helping care providers and their patients in real-life situations makes me beyond excited. What I can say is that even though we are continuously applying our clients’ feedback to our new features, we are always here to do our best to help providers as they continue to take care of our physical and mental health, working as efficiently as they can.

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Do I Need A Fabulous Website to Market My Therapy Practice?

My name is Traci Ruble, CEO of PSYCHED in San Francisco therapy center and Managing Director of a Sidewalk Talk, a nonprofit community listening project.  I am a longtime fan of Mentegram and will be a monthly contributor to this blog. Thank you for reading my first contribution.

A little more about me.  I came of age during the high-tech boom in the Bay Area.  I was a tech sales and marketing professional.  I learned a lot about business, but I didn’t know how to run my own business.  Now I lead a clinic and magazine, as well as a nonprofit with 600 volunteers globally.

I am busy in all the best, most life affirming ways. But that leaves me always looking for efficiency.

Let’s bring this back to you.  You already know it is a lot of work running your own business (something most psychology grad schools fail to mention to therapists coming up).  In the early days of first launching a private practice, the most important piece of your work is marketing yourself so you can fill your case load and keep a revolving door of referrals coming back to you.

When I first started marketing my practice I wanted to know, “What do therapists with full practices do to market themselves?”  I was already internet savvy at the time.  I was an early adopter in creating a website and a Google Place Page, but I wanted to go talk to those who came before me, so I crafted a survey and sent it out to my city-wide list of therapists.  One hundred responded.  Here is what I learned.

You will be surprised how the therapists I surveyed used the web.

Therapists with full practices had two things in common across the board.  First, they were on LinkedIn.  Second, they had a presence either on Psychology Today or Good Therapy.  Half of them did not have a website (gulp!).  Your website, unless you are going to pay for an expensive SEO person or buy a lot of advertising, isn’t going to show up on search results.  Instead, the website is more like a business card for therapists.  Most people find your website because someone referred them directly to you.  So it is imperative you think about that when you write content for your site and the tools (like Mentegram– eh hem) you use to make it easy for referrals to engage with you.

What was the #1 thing these therapists did to get referrals?

The number one thing therapists I surveyed did is develop collegial bonds with other clinicians.  And no, not the wine and dine kind.  They had regular consultation groups and trainings, and in those trainings, clinicians get to know one another’s “therapeutic style” and skill.  The trust they build in one another’s work leads them to start referring to one another.  What a relief to not have to go to a therapist meet and greet, right?

This is also where Mentegram comes into play.  This kind of time investment adds to your already busy life.  So investing in technology that saves you time enables you to do the #1 thing successful therapists do – engage in regular consultation and training.  It is a fun way to be in community, grow your skills, and now you know it is useful marketing, too.

Looking forward to talking to you all next month.

Traci

 

Author Biography:

Traci is a therapist and the CEO of PSYCHED & Managing Director of Sidewalk Talk. Her therapy work is centered around working with couples and individuals working on their relationships. Her many years in corporate life make her a good match for executives and leaders.

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Are you ever worried about having to understand and use a new software?

When it comes time to begin using new software, there are always those pesky questions that come to mind. Will it be difficult to use? Will it take forever to learn? Will I even be able to figure it out at all?

Learning to work with a new software can be stressful, but it doesn’t have to be! A software doesn’t need to have confusing layers and templates to function the way that you need it to, which is fast and error-free, giving you more time for the things that really matter! If you pick the right software, investing one hour into understanding how it works and seeing how much it can help you is going to be one of the best investments you’ve ever made.

Whether you’re taking therapy notes, screening patients or scheduling appointments, be sure to find a software with interfaces that are straightforward and simple to use. If this all sounds good to you, then take a look at what new technology has to offer your private practice.

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CPT Code 96127 – Answers to the frequently asked questions about billing this code

Although it has only been around since early 2015, CPT Code 96127 has been getting more and more attention only recently. However, with not a lot of experience with billing this code, many providers still don’t want to bill it, and even if they wanted to, they don’t know how. Our customers have successfully billed this code. Therefore, we’d like to share our experience and answer the most common questions that you may have about billing CPT code 96127.

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Are you worried about the security of your clients’ personal and health data?

When a patient walks into your private practice, they are not only believing in you to assist with their mental healthcare needs, but they are entrusting you with their very private personal and health data. No one should know better than a therapist just how important this trust can be between therapists and their patients.

Rather than worry them needlessly by using software and programs that aren’t HIPAA compliant, set their minds at ease with the promise of safe, secure methods to help build better patient engagement. Their private data can also always be just a click away, organized to your satisfaction, but without running the risk of being compromised.

Always make certain that all of your software is HIPAA compliant. It should offer therapists the features that they need, while also providing their clients with the assurance that they deserve.