It can be a complicated ordeal getting billing done for services pertaining to mental health. Many things have to be included during billing, such as the proper CPT codes for whatever services were provided, as well as the correct diagnoses codes. This doesn’t even take into account the fact that you’re doing this while simultaneously caring for all of your clients.
With all of this said, billing is an essential part of any medical practice. Proper billing is needed to ensure your practice runs smoothly. Unfortunately, there are many errors that can take place. Here are some of the most likely errors that take place whenever CPT codes are used for mental health.
The Wrong Kind of CPT Code Gets Used
Procedure codes have to be very specific, especially when discussing the duration of a session. Sometimes, coders may end up using codes that aren’t appropriate for the amount of time spent. For example, when you use codes that are meant for longer sessions, even when the actual session was shorter, you’ll end up over-billing. On the flip side, it’s possible to under bill patients if you don’t factor additional services into the total.
Using Codes That are Outdated
Both the set of CPT codes, as well as the ICD codes, are updated frequently. Therefore, keeping up with all of the coding changes is necessary. When you use outdated codes, your cash flow can be harmed because it takes more time for you to get reimbursed.
Unbundling Codes
When we talk about “unbundling codes,” we’re talking about situations in which many different CPT codes get used for a service when you could reflect the entire session with only one code. Unbundling codes ends up raising payment, and even if you don’t mean to do so, payers are going to raise eyebrows at companies that do this. They may suspect that fraud or abuse is at play.
Upcoding
Upcoding means that you use codes that have greater reimbursement rates when it’s not appropriate. Much like with unbundling, upcoding can result in an investigation to determine if fraud or abuse is at play, especially if you engage in upcoding regularly.
Improperly Using Modifiers
Modifiers are codes with two digits which get attached to CPT codes, and their purpose is to give payers more information on whatever services were provided. There are rules that must be followed when you’re using modifiers, though, and if they are used incorrectly, claims get denied. You might also get flagged for fraud or abuse if you don’t use modifiers the right way.
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