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Reminder Regarding Behavioral Health Service Codes

Effective January 1, 2013, the American Psychiatric Association made recommendations to revise existing behavioral health service codes to more accurately capture the clinical work performed by psychiatric providers. These codes were published by the American Medical Association (AMA) in the Current Procedure Terminology (CPT) coding reference guide. When code revisions such as these are made, Blue Cross and Blue Shield of North Carolina (BCBSNC) reviews the proposed, eligible CPT code modifications based on our internal reimbursement methodology and in accordance with the AMA’s recommendations and CPT coding guidelines.

We have experienced an increased utilization of these codes since the effective date, and our purpose through this communication is to provide a reminder about the correct coding for these E&M services.

Please refer to the “Medicine” section in the most current CPT guide for a list of procedure codes you should use to bill psychiatric and chemical dependency services. In accordance with the January 1, 2013, CPT code changes by the AMA, psychiatrists who provide psychotherapy E&M services should bill using the appropriate E&M code for the medical services, along with a timed add-on code for the psychotherapy.

It is expected that the documentation showing the complexity, patient’s history and physical will support the billing codes for each visit in accordance with CPT coding guidelines for the medical evaluation and management (E & M) services, for BCBSNC members.  Your contract with BCBSNC includes the provision that BCBSNC may request that you furnish all reasonably required information, including a member's medical record, to verify and substantiate the provision of services to that member. Your contract also requires you to obtain any consents and authorizations needed from a patient in order for you to provide this information to BCBSNC.

Refer to the following sources for additional correct coding guidance:

1) MS Internet Only Manual (IOM) Medicare Claims Processing Manual, Publication 100-04, Chapter 12, Section 30.6.1 found at http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf

2) Refer to http://www.psychiatry.org/practice or call the organization at 1-800-343-4671. You can review the 2014 CPT professional reference guide or these additional sources:

 

If you have any questions, please contact us via the Provider Blue LineSM at 1-800-214-4844, or contact your BCBSNC Strategic Provider Relationships consultant.