Read HIPAA Compliancy Code Chart BH Revisions 4-04 (2).xls text version

NETWORK HEALTH HIPAA-COMPLIANT CODE CHART FOR BEHAVIORAL HEALTH SERVICES

HIPAA-Compliant Revenue Code (effective 10/16/03) HIPAACompliant CPT or HCPCS (effective 10/16/03) HIPAACompliant Modifier (effective 10/16/03)

Codes used before 10/16/03

Service

Service Description

Modifier Description

Units (effective 10/16/03)

Network Health-Specific Comments

INPATIENT BEHAVIORAL HEALTH SERVICES 124 Inpatient mental health - adult 114, 124, or 134 Inpatient psychiatric: room and board 114: private room 124: semi-private room - two beds 134: semi-private room - three and four beds Inpatient psychiatric: room and board 114: private room 124: semi-private room - two beds 134: semi-private room - three and four beds Inpatient psychiatric: room and board 114: private room 124: semi-private room - two beds 134: semi-private room - three and four beds 119: other 129: other 139: other 119: other 129: other 139: other Inpatient detoxification: 116: private room 126: semi-private room - two beds 136: semi-private room - three and four beds 762: Observation room with MH or SA diagnosis 1 unit = 1 day of service

124

Inpatient mental health - pediatric

114, 124, or 134

1 unit = 1 day of service

159

Inpatient neuropsych

114, 124, or 134

1 unit = 1 day of service

ADMIN

Administrative necessary day (AND)

119, 129, or 139

1 unit = 1 day of service

ADMIN1

Post-acute youth AND

119, 129, or 139

1 unit = 1 day of service

126

Inpatient substance abuse level IV

116, 126, or 136

1 unit = 1 day of service

910

Observation/holding beds

762 with MH/SA diagnosis 912 H0037 TG

1 unit = 1 day of service

Submit claim for 762 with MH or SA diagnosis

DIVERSIONARY BEHAVIORAL HEALTH SERVICES 912 103 Partial hospitalization Intensive community-based acute treatment for children Community-based acute treatment for children 912: Partial hospitalization 1001: Residential treatment - psychiatric H0037: Community psychiatric support treatment program, per diem 1001: Residential treatment - psychiatric H0037: Community psychiatric support treatment program, per diem C47 HH 1002: Residential treatment - chemical dependency H0037: Community psychiatric support treatment program, per diem S9485: Crisis intervention, per diem 1 unit = 1/2 day 1 unit = 1 day of service

100

H0037

1 unit = 1 day of service

104

Community-based acute treatment for dual diagnosis

H0037

1 unit = 1 day

X5603

Crisis stabilization

S9485

TG

TG = complex/high-tech level 1 unit = 1 day of care

TG = Network Health-specific modifier to further specify CSB from emergency or mobile screening

X5610 Phase I, X5611 Phase II, X5612 Phase III X5614 X9189 X5618 136

Family stabilization team

H2019

Therapeutic behavioral services, per 15 minutes

Unit change: 1 unit = 15 minutes 1 unit = 1 day Unit change: 1 unit = 1 hour 1 unit = 15 minutes 1 unit = 1 day of service

Intensive outpatient program (MH) Psychiatric day treatment Community support program Acute treatment services - substance abuse level IIIA

0905 H2012 H2015 H0011

Intensive outpatient services - psychiatric H2012: Behavioral health day treatment, per hour H2015: Comprehensive community support services, per 15 minutes 1002: Residential treatment - chemical dependency H0011: Alcohol and/or drug services, acute detoxification (residential addiction program inpatient) TH

146

Acute treatment services - substance abuse pregnancy enhanced

H0011

1 unit = 1 day of service 1002: Residential treatment - chemical dependency TH = obstetrical treatment/services, prenatal or H0011: Alcohol and/or drug services, acute postpartum detoxification (residential addiction program inpatient) with TH modifier 1002: Residential treatment - chemical dependency H0011: Alcohol and/or drug services, sub-acute detoxification (residential addiction program inpatient) *** this service is being eliminated for ages 21 and over; these codes only apply to patients under 21 1 unit = 1 day of service

X5605

Clinical support services - substance abuse (aka level IIIB)

H0010

1

Rev. 6/04

NETWORK HEALTH HIPAA-COMPLIANT CODE CHART FOR BEHAVIORAL HEALTH SERVICES

HIPAA-Compliant Revenue Code (effective 10/16/03) HIPAACompliant CPT or HCPCS (effective 10/16/03)

H0015

Codes used before 10/16/03

X5613

Service

HIPAACompliant Modifier (effective 10/16/03)

Service Description

Modifier Description

Units (effective 10/16/03)

1 unit = 1/2 day

Network Health-Specific Comments

Structured outpatient addiction program (SOAP)

Alcohol and/or drug services; intensive outpatient treatment program that operates at least three hours/day and at least three days/week, and is based on an individualized treatment plan including assessment, counseling, crisis intervention, and activity therapies or education Intensive outpatient services - chemical dependency

X5614 X2203

Intensive outpatient program (SA) Acupuncture treatment

0906 97780 HF

Unit change: 1 unit = 1 day 1 unit = 1 visit

Acupunture with one or more needles without electrical stimulation Mental health service plan development by nonphysician

HF = substance abuse program

OUTPATIENT BEHAVIORAL HEALTH SERVICES Inpatient-outpatient bridge consultation 90801 with modifiers Psychiatric diagnostic evaluation H0032 90801 1 unit = 1 hour U6 = MD/DO SA = RNCS AH = Psychologist (Lic.) HO = Masters U7 = CAC/CAD AC 1 unit = 1 hour

U6, SA, AH, HO, Psychiatric diagnostic interview examination U7

90804 with modifiers Individual psychotherapy, outpatient, 20-30 minutes

90804

U6, SA, AH, HO, Individual psychotherapy, insight oriented, behaviorU6 = MD/DO TD, U2, U3, U4 modifying and/or supportive, in an office or SA = RNCS outpatient facility, approximately 20-30 minutes, AH = Psychologist (Lic.) face-to-face with patient HO = Masters TD = RN U2 = CAC/CAD AC U3 = Psych intern U4 = Social work intern U6, SA Individual psychoterapy with medical evaluation and management, outpatient, 20-30 minutes U6 = MD/DO SA = RNCS

1 unit = 20-30 minutes

90805 with modifiers Individual psychotherapy, with medical evaluation and management, outpatient, 20-30 minutes 90806 with modifiers Individual psychotherapy, outpatient, 45-50 minutes

90805

1 unit = 20-30 minutes

90806

U6, SA, AH, HO, Individual psychotherapy, insight oriented, behaviorU6 = MD/DO SA = RNCS TD, U3, U4, U7 modifying and/or supportive, in an office or outpatient facility, approximately 45-50 minutes, AH = Psychologist (Lic.) face-to-face with patient HO = Masters TD = RN U3 = Psych intern U4 = Social work intern U7 = CAC/CAD AC U6, SA Individual psychoterapy with medical evaluation and management, outpatient, 45-50 minutes U6 = MD/DO SA = RNCS U6 = MD/DO SA = RNCS AH = Psychologist (Lic.) HO = Masters TD = RN U3 = Psych intern U4 = Social work intern U7 = CAC/CAD AC U6 = MD/DO SA = RNCS AH = Psychologist (Lic.) HO = Masters TD = RN U3 = Psych intern U4 = Social work intern U7 = CAC/CAD AC

1 unit = 45-50 minutes

90807 with modifiers Individual psychotherapy, with medical evaluation and management, outpatient, 45-50 minutes 90847 with modifiers Couples/family therapy

90807

1 unit = 45-50 minutes

90847

U6, SA, AH, HO, Family psychotherapy TD, U3, U4, U7

1 unit = 60 minutes

90849 with modifiers Multi-family group therapy

90849

U6, SA, AH, HO, Multi-family group therapy TD, U3, U4, U7

1 unit = 90 minutes

2

Rev. 6/04

NETWORK HEALTH HIPAA-COMPLIANT CODE CHART FOR BEHAVIORAL HEALTH SERVICES

HIPAA-Compliant Revenue Code (effective 10/16/03) HIPAACompliant CPT or HCPCS (effective 10/16/03)

90853

Codes used before 10/16/03

90853 or 90857 with Group therapy modifiers

Service

HIPAACompliant Modifier (effective 10/16/03)

Service Description

Modifier Description

Units (effective 10/16/03)

1 unit = 60-90 minutes

Network Health-Specific Comments

U6, SA, AH, HO, Group psychotherapy (other than of a multiple TD, U3, U4, U7 family group)

U6 = MD/DO SA = RNCS AH = Psychologist (Lic.) HO = Masters TD = RN U3 = Psych intern U4 = Social work intern U7 = CAC/CAD AC U6 = MD/DO SA = RNCS AH = Psychologist (Lic.) HO = Masters TD = RN U3 = Psych intern U4 = Social work intern U7 = CAC/CAD AC U6 = MD/DO SA = RNCS AH = Psychologist (Lic.) HO = Masters TD = RN U3 = Psych intern U4 = Social work intern U7 = CAC/CAD AC

90882 with modifiers Case consultation

90882

U6, SA, AH, HO, Environmental intervention for medical TD, U3, U4, U7 management purposes on a psychiatric patient's behalf with agencies, employers, or institutions

Unit Change: 1 unit = 15 minutes

90887 with modifiers Family consultation

90887

U6, SA, AH, HO, Interpretation or explanation of results of TD, U3, U4, U7 psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient

Unit Change: 1 unit = 15 minutes

Assessment for safe and appropriate placement (ASAP)

H2028

U6, SA, AH, HO Sexual offender treatment service, per 15 minutes U6 = MD/DO SA = RNCS AH = Psychologist (Lic.) HO = Masters U6, SA Pharmacologic management including prescription U6 = MD/DO use and review of medication with no more than SA = RNCS minimal medical psychotherapy Therapeutic, prophylactic, or diagnostic injection (specify material injected); subcutaneous or intramuscular Mental health services not otherwise specified U6 = MD/DO SA = RNCS TD = RN

Unit Change: 1 unit = 15 minutes

90862 with modifiers Medication visit

90862

1 unit = 15 minutes

90782 with modifiers Medication administration

90782

U6, SA, TD

1 unit = 1 visit

S4337

Collateral contact

H0046

UK

Services provided on behalf of 1 unit = 15 minutes the client to someone other than the client; collateral relationship 1 unit = 1 dose

259

Methadone administration

H0020

Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) UA Alcohol and/or drug services; methadone Individual administration and/or service (provision of the drug by a licensed program); individual medthadone counseling Alcohol and/or drug services; methadone Group administration and/or service (provision of the drug by a licensed program); group medthadone counseling Alcohol and/or drug services; methadone Family administration and/or service (provision of the drug by a licensed program); family medthadone counseling Electroconvulsive therapy (including necessary monitoring); single seizures Electroconvulsive therapy (including necessary monitoring); multiple seizures AH, U3 Psychological testing (includes psychodiagnostic AH = Psychologist (Lic.) assessment of personality phychopathology, U3 = Psych intern emotionality, intellectual abilities, e.g. WAIS-R Rorschach, MMPI) with interpretation and report, per hour Neuropsychological testing battery (e.g. Halstead- AH = Psychologist (Lic.) Reitan, Luria, WAIS-R) with interpretation and U3 = Psych intern report, per hour Crisis intervention, per diem Crisis intervention, per diem

3

914

Methadone counseling - individual

H0020

1 unit = 30 minutes

UA = Network Health-specific modifier for individual methadone counseling

915

Methadone counseling - group

H0020

HQ

1 unit = 60-90 minutes

916

Methadone counseling - family

H0020

HR

1 unit = 60 minutes

OTHER OUTPATIENT SERVICES 90780 90781 ECT outpatient - single seizure ECT outpatient - multiple seizures 901 901 90870 90871 96100 1 unit = 1 day of service 1 unit = 1 day of service Unit change: 1 unit = 1 hour

96100 with modifers Psychological testing

96117 with modifiers Neuropsychological testing

96117

AH, U3

Unit change: 1 unit = 1 hour

EMERGENCY BEHAVIORAL HEALTH SERVICES (by designated ESP) X5600 X5911 Mobile screening Emergency screening S9485 S9485 Per diem Per diem

Rev. 6/04

NETWORK HEALTH HIPAA-COMPLIANT CODE CHART FOR BEHAVIORAL HEALTH SERVICES

HIPAA-Compliant Revenue Code (effective 10/16/03) HIPAACompliant CPT or HCPCS (effective 10/16/03)

S9484

Codes used before 10/16/03

X5539

Service

HIPAACompliant Modifier (effective 10/16/03)

Service Description

Modifier Description

Units (effective 10/16/03)

Unit change: 1 unit = 1 hour 1 unit = 15 minutes

Network Health-Specific Comments

Short-term crisis intervention/follow-up counseling

Crisis intervention, per hour

99292

Specializing

T1004

Services of qualified nursing aide, up to 15 minutes

INPATIENT CONSULTATION AND PSYCHOTHERAPY (e.g., while patient is on medical inpatient unit or skilled nursing/nursing home) 99251 Inpatient consultation 99253 Inpatient consultation 90816 with modifiers Individual psychotherapy (inpatient/nursing facility) 99251 99253 90816 Initial inpatient consultation (by physician) Initial inpatient consultation (by physician) U6, SA, AH, HO Individual psychotherapy in an inpatient hospital or U6 = MD/DO residental care setting, approximately 20-30 SA = RNCS minutes face to face with the patient AH = Psychologist (Lic.) HO = Masters U6, SA Individual psychotherapy in an inpatient hospital or U6 = MD/DO residental care setting, approximately 20-30 SA = RNCS minutes face to face with the patient with medical evaluation and management services 1 unit = 20-30 minutes 1 unit = 55-60 minutes 1 unit = 20-30 minutes

90817 with modifiers Individual psychotherapy with medication management (inpatient/nursing facility)

90817

1 unit = 20-30 minutes

90818 with modifiers Individual psychotherapy (inpatient/nursing facility)

90818

U6, SA, AH, HO Individual psychotherapy in an inpatient hospital or U6 = MD/DO residental care setting, approximately 45-50 SA = RNCS minutes face to face with the patient AH = Psychologist (Lic.) HO = Masters U6, SA Individual psychotherapy in an inpatient hospital or U6 = MD/DO SA = RNCS residental care setting, approximately 45-50 minutes face to face with the patient with medical evaluation and management services

1 unit = 45-50 minutes

90819 with modifiers Individual psychotherapy with medication management (inpatient/nursing facility)

90819

1 unit = 45-50 minutes

Definitions

Clinician Modifiers used until 10/15/03

Current procedural terminology. A procedure code set maintained and copyrighted by the AMA, and that as been selected for use under HIPAA for non-institutional and non-dental professional transactions. HCFA Common Procedural Coding System. A medical code set that identifies health care procedures, equipment, and supplies for claim submission purposes. It has been selected for use in HIPAA transactions. A two-digit code that has been selected for use in HIPAA transactions that indicates services or procedures have been altered by some specific circumstance. Modifiers do not change the definitio of the reported procedure codes. A three-digit numeric code that has been selected for use in HIPAA transactions that describes the type of service provided. AD

Clinician Modifier Description used until 10/15/03

HIPAA-Compliant Clinician Modifiers (effective 10/16/03)

U7

Clinician Modifier Description (effective 10/16/03)

CAC/CAD AC

CPT code

CAC/CAD AC

HCPCS code

CS

Clinical specialist

SA

RNCS, Nurse Practitioner

Modifier

MA

Master's clinician

HO

Master's clinician

Revenue code

MD PI PS RN SI

Psychiatrist Psychology intern Psychologist (licensed) Registered nurse Social work intern

U6 U3 AH TD U4

Psychiatrist/DO Psychology intern Psychologist (licensed) Registered nurse Social work intern

4

Rev. 6/04

Information

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