magellan code changes

7/29/2019 Magellan code changes

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CPT Code Changes 2013


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What are CPT Codes?Current ProceduralTerminology (CPT)

codes are developed

by the AMA, whocontracts with CMS tobe the official coding

systemDescribes medical,surgical, diagnostic

services

Communicatesuniform information

about medicalservices andprocedures

Identifies servicesrendered rather thandiagnoses as in DSM

and ICD-9 and 10

Under HIPAA,providers and insurers

are required to useCPT codes to identify

their services

Magellan must buylicenses from AMA to

use CPT codes

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CPT Code Changes for 2013

The AMA issued major changes to behavioral CPT codes impacting both

payors and providers.

CPT codes changes affect 908x series therapy codes including the

replacement of 90862, and require the use of 99 codes, specifically the

9920x and 9921x series, by psychiatrists and advanced practice nurses.

These changes apply to any services provided beginning January 1, 2013.

Numerous Magellan work groups have been working diligently since May to

update our systems for this change.

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The Big Picture

The new CPT codes are mandatory; non-compliance is a HIPAA violation.

The switch to the new codes is based on the date of service, not the date

the claim was submitted. For dates of service prior to Jan. 1, you can bill

with the old codes and the claim will pay.

The AMA does not allow for a transition period. Providers must bill withnew CPT codes on Jan. 1 for dates of service on or after Jan. 1 or the claim

will deny. This includes electronic claims.

Code changes impact all provider types, not just psychiatrists.

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The Changes

Most 908xx codes we are familiar with have

been changed908xx

Medication management, has been eliminated90862

Psychiatrists and other physicians must use E/M(Evaluation and Management) codes 992xx with

an add-on code if psychotherapy is performed

992xx

90801 has been eliminated90801

Now initial evaluation with medical services-90792; withoutmedical services 90791

90792 and 90791

If initial evaluation code 90791 or 90792 isinteractive, appropriate add-on code must beused

Interactive code may be used with E&M onlywhen add-on psychotherapy codes are used

Interactive

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The Changes

Psychotherapy for patient in crisis-60minutes90839

Crisis beyond 60 minutes, +90840 per eachadditional 30 minutes

+90840

Add-on for medication management andpsychotherapy by psychologist

+90863

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Used in conjunction with another primary code-indicated by a (+)

Added to 99xxx codes to denote psychotherapy in addition to evaluationand management services (see next slide)

Added to denote interactive psychotherapyuse of device or interpreter

+90785

Initial evaluation codes (90791 or 90792)

To evaluation and management codes (99xxx codes) if add-on

psychotherapy code is used

To psychotherapy codes

To group psychotherapy codes

Used with crisis therapy for each 30 minute session beyond thefirst hour +90840

Whats An Add-On Code?

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Psychotherapy Codes

Codes simplified and expanded

Includes time with patient and/or family member

Only 3 timed codes:

90832 30 minutes

90834 45 minutes 90837 60 minutes

If E/M provided, timed add-on codes for psychotherapy

+90833 30 minutes

+90836 45 minutes

+90838 60 minutes

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A Few Codes Remain the Same!

9

90845

Psycho-analysis

90846

Familytherapy-patient notpresent

90847

Familytherapy-patientpresent

90849

Multi-familygrouptreatment

90853

Grouptherapy


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Evaluation and Management (E/M) codes

Psychiatrists must use E/M codes for services such as medicationmanagement

These codes are the same ones all physicians use for similar services, and

use the numbers 99xxx

Documentation requirements are much more specific for these codes andrequire addressing various degrees of medical complexity

APA has a training program online for psychiatrists in the use of these codes

Physician extenders will also use these codes, but not other mental health

professionals

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Evaluation & Management Services

Office/Outpatient services

99203-99205 New Patient Office Visit

99211-99215 Established Patient Office Visit

9924x Outpatient Consult

Inpatient/Hospital Services

99221-99223 Initial Hospital Care

99231-99233 Subsequent Hospital Care

Nursing facility care 99304

Home visit 99341

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Case Examples

1 John Smith, MD is providing medication checkservices to Mr. Jones. He spent about 15minutes with the patient.

What code should

he bill Magellan?

99212

2After this patient, Dr. Smith evaluates a newpatient who does not speak English, and an

interpreter is used.

What code shouldhe bill Magellan?

90792+

90785

3 Dr. Smith has asked his LCSW, Ms. Brown, tolead a group therapy session with 8 patients.What code should

she use to bill?

90853

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Case Examples

4Dr. Green is conducting a 60-minute psychotherapy session.During the session, the patient becomes agitated, psychoticand suicidal. Dr. Green must spend an extra 30 minutes to

calm him down.

What code

should he use tobill?

90839+

90840

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Dr. Green is having a session with a 13-year-oldpatient for depression and alcohol abuse. The

patient is on an antidepressant and an inhaler forher asthma. She presents with both of her

parents, who are divorced and arguing over howto address the patients recent alcohol binge.

One parent wants to send her away to a

boarding school. The other parent wants tofollow the previously agreed upon course of

treatment.

What codeshould he

use?

99212

+90836

+90785

6Dr. Smith has a patient in the hospital. He conducts a 45-

minute psychotherapy session, and evaluates the patients

reaction to his medication.

What code

should he use?

99221+

90836

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What you can expect to see from us:

A dedicated CPT Code page, which offers updated information and links,

on www.MagellanHealth.com/provider under Getting Paid/HIPAA

News Headlines and Provider Focus articles on the provider site

A reminder notice when logging on to our secure provider website

CPT Code messages on hardcopy EOBs A contract amendment mailing with FAQs

Provider webinars

And, additional regional outreach as needed

Communicating Updates

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http://www.magellanhealth.com/providerhttp://www.magellanhealth.com/provider


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Questions

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