“Coding” is not a four-letter word

By Wyn Staheli
January 1, 2004 - Last updated: May 31, 2011

If you mention the word “coding” with behavioral health colleagues, don’t be surprised when they plug their ears and start mumbling, “la-la-la-la-la-la-la.” After all, why should they worry about coding, they can only use two or three codes, right? Wrong.

Since 2001, 156 new codes related to mental health have been added to the mental health provider’s arsenal. Not being familiar with or not using these codes costs providers both money and respect. Proper coding not only increases your cash flow and serves your patients better, but also classifies you as a medical provider, not just a mental health provider.

Treating patients quite often involves more than just an individual therapy session or an assessment. It is likely that patient care includes:

  • Health and behavior assessment.
  • Hotline service.
  • Alcohol and/or drug assessment.
  • Crisis intervention service.
  • Behavioral health day treatment.
  • Alcohol and/or other drug treatment program.
  • Social work visit, in the home.
  • Case management.

Each of these services is considered “billable,” and you should be getting paid for them when provided.

For example, in my area crisis intervention services could be billed for $120 per hour. Before the new code, chances of reimbursement from an insurance carrier were slim. But here, one major state carrier will pay 70 percent of the billed amount. That’s $84 I don’t have to collect from the patient. It is also better than billing a psychotherapy session and receiving $60 under a typical 50 percent coverage plan. Patients benefit by more efficient use of their health insurance coverage and a more accurate representation of their case history when reviewed by other health care providers.

The new H&B codes (96150-96155) are considered medical services – not behavioral health services. Therefore, insurance coverage should not be subject to outpatient visit limitations and should be paid at higher medical reimbursement rates. Imagine an 80/20 split instead of a 50/50 split. Many excellent resources are available to help you become more familiar with these new codes, such as the Behavioral Health MultiBook, which is available from InstaCode Institute (www.instacode.com).

Perhaps the most exciting thing about the new H&B codes is that they are considered medical services. This opens the door for mental health to shed the stigma of “alternative” medicine in the minds of the medical community, insurance industry and the general public. Use of these codes enables greater integration of psychology services with all health care providers.

The bottom line is this: The recent code changes and additions open an entirely new market to the mental health provider with better reimbursement and more respect. Sure you’re going to have to change a few old habits, but I bet you know a good counselor to help you through it. CE


Wyn Staheli has been involved in the coding industry since 1985. She is currently the CEO of InstaCode Institute. Questions or comments can be directed to her at (435) 574-2592, or her e-mail address is: staheli@instacode.com

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