A Coding Guide for Behavioral Health and Addiction Treatment Facilities

by | Aug 14, 2023 | Addiction, Behavioral Health, Claim Denials, Minimize Errors, Revenue, Staff Training

Billing Solutions Team
Billing Solutions provides medical billing services for behavioral healthcare practices.

It is essential for the health of your practice to receive maximum reimbursement rates for your services. There are many current procedural terminology (CPT) codes to choose from in this complex system and if you have multiple clinicians you may have found your reimbursement to vary amongst each clinician. It is important to note that the different billing codes utilized by the clinicians may result in lost revenue for your practice.

If this is something you are experiencing, and you have multiple clinicians in your facility, you may find a coding checklist to be a wise source for accuracy with an elimination of simple errors, fewer payment delays, fewer claim denials, and maximum reimbursement rates.

It is noted that not all clinicians are reimbursed for all substance abuse services. Therefore, for your facility, at the outset, identifying what each clinician is reimbursed for will save you time in reprocessing claim denials. The reimbursement rates depend on the insurance payer, location and the clinician’s practice level.

Coding Checklist Implementation

First, identify whether the billing patterns differ amongst your clinicians.

  • What are the most common codes used for the services your facility provides?
  • Which clinicians are not reimbursed for substance abuse services?
  • What claims are being denied?
  • Are clinicians accurately documenting time spent delivering services?
  • Is there a common code being denied by insurances?
  • Is there a code not being submitted, though you have provided the service?

Second, create a coding checklist of approved CPT codes, proper use of modifiers, allowable ICD diagnoses, allowable POS, and whether telehealth services are covered and then distributed to your clinicians.

For example,

H0005 – Alcohol and/or drug services; group counseling by a clinician [1.0 = 60 minutes]

  • Modifier required
    • Bachelor’s degree level – HN
    • Master’s degree level – HO
    • Doctoral level – HP
    • MD – UA
  • ICD Diagnoses Allowed
    • F10 -F19.99
    • F55.0-F55.8
  • Allowable POS
    • 03, 11, 22, 23, 31, 32, 54
  • Telehealth Services Covered?
    • No

    H0022 – Alcohol and/or drug intervention service (planned facilitation) [quantity of 1.0 = per person in group per 60 minutes]

  • Modifier required
    • Bachelor’s degree level – HN
    • Master’s degree level – HO
    • Doctoral level – HP
    • MD – UA
  • ICD Diagnoses Allowed
    • F10 -F19.99
    • F55.0-F55.8
  • Allowable POS
    • 03, 11, 21, 22, 23, 31, 32, 51, 54, 61
  • Telehealth Services Covered?
    • Yes (use “GT” modifier)

    It is imperative that each clinician perform the services that they bill the insurance company for, otherwise issues may arise with insurance companies. Clinicians should claim only what is medically necessary, file the claims on time and make sure they have correct coding.

    As your facility grows, and you add more clinicians, the coding checklist implementation with the correct codes for each clinician will be foundational in the billing process and will decrease managerial stress, claim rejections, and will increase reimbursement rates.

    CPT Coding Training for Staff

    If you are struggling with your billing and are experiencing slow reimbursements or a high number of denied claims, consider contacting us for staff training. Billings Solutions offers onsite educational strategies to improve billing practices among your clinicians. Our qualified staff instructs each clinician in the process of insurance billing, proper use of modifiers (that can make the difference between maximum reimbursement and minimal reimbursement), their responsibility and how to maintain consistent best practices for an efficient billing system. We go over the reasons for claim denials and will offer understandable quality solutions, making sure your documentation accurately portrays the level of care you are providing.

    Reach out to us today for a free account review and analysis.