Managing Mental Health Medical Codes

When developing or rebutting a life care plan or writing a bill review, life care planners must be aware of medical billing codes and corresponding definitions that can be utilized specific to the diagnosis and treatment of mental health. This article will review the Current Procedural Terminology (CPT) codes as well as provide resources for several national associations applicable to the delivery of mental health care.

Historically, the American Medical Association (AMA) created the Current Procedural Terminology (CPT) coding system in 1966 as a method of standardizing reporting needed for reimbursement of services performed by healthcare providers (AAPC; CPT). Evaluation and management (E/M) codes are used by physicians, nurse practitioners and physician assistants and are formatted based on 1) the numeric code, 2) the place where and or the type of service provided (inpatient or outpatient), 3) the actual service provided based on the code definition, and 4) the time spent as specified in the code definition. E/M codes are found CPT 99202 – 99499; code 99211 and 99281 are exceptions as those codes may be used with other clinicians (CPT® Evaluation and Management (E/M) Code and Guidelines Changes).

Time components stated in E/M codes include both face-to- face time spent with the patient and the family or caregiver as well as non- face-to-face activities including locating medical records and test results, communicating with additional members of the care team and coordinating care (Sophocles, A. 2003). Time based codes used for various therapies indicate that the time spent directly with the patient, typically occurring in 15 minute increments, (Tornese, N. 2023), four units totals one hour of therapy, for example. Reviewing the definition of individual CPT codes will assist in determining if the code is time or unit based. Untimed or unit-based codes indicate the provision of a service regardless of the time spent, often once per day (Centers for Medicare & Medicaid Services). Mental health related timed codes are included in both E/M and therapeutic modalities.

To view the full article, please click here, Cook, D. L. (2023) “Managing Mental Health Medical Codes” Journal of Nurse Life Care Planners. Summer 2023, vol. XXIII NO. 3- pp. 18-24.

To view the Journal of Nurse Life Care Planners, please click here.