Psychiatrist medical billing | Headway

Key terminology in psychiatric billing

As in other areas of mental health treatment, a thorough understanding of various codes — and, more important, when to use them — is crucial to successful and accurate billing for prescribers. Here’s an overview of some key terminology in psychiatric billing.

CPT codes

A large part of billing includes understanding CPT codes, which psychiatrists (among other healthcare providers) use to describe their services. These services can include psychiatric evaluation, psychotherapy, and medicine management.

ICD-10 codes

While CPT codes convey the service for which you’re billing, ICD-10 codes indicate your client’s diagnosis. (ICD stands for International Classification of Diseases.) Each ICD-10 code includes alphanumeric characters that represent specific diseases, injuries, and medical conditions, including psychological diagnoses.

E/M codes

When psychotherapy is provided during the same visit as medical services, it should be reported using an add-on code along with the E/M code. The E/M code, type of CPT code, covers the medical portion of the visit—like medication management or coordination of care—while the add-on code reflects the separate time spent on psychotherapy.

E/M codes are selected based on either the complexity of medical decision-making (MDM) or the total time spent on medical services.

When selecting an E/M code based on time, you can include both face-to-face and non-face-to-face time spent on medical activities performed on the date of service—such as reviewing records, prescribing medication, and coordinating care. However, time spent on psychotherapy cannot be included in the E/M time total. That time must be reported separately using the appropriate psychotherapy add-on code

Medical decision making

Medical decision-making, or MDM, is a type of decision making that helps establish diagnosis, assess the status of a condition, and determine the right kind of management. It’s typically broken into three elements:

1. The number and complexity of problem(s) that are addressed during the session.

2. The amount or complexity of data you need to review and analyze. This data includes medical records, tests, and/or other information that must be obtained, ordered and reviewed. This also might include information obtained from multiple sources or other team members.

3. The risk of complications, morbidity or mortality arising from management decisions made at the visit—associated with the client’s problem(s), the diagnostic procedure(s), and treatment(s).

Common billing challenges

As a psychiatrist, you’re likely to encounter roadblocks when it comes to billing and collecting payment for services you’ve provided your clients. Here are some common ones, plus a few helpful tips to help ease any pain points.

Claim denials and rejections

It happens to everyone: You’ve submitted what you think is a perfectly completed claim form only to discover later that the claim has been rejected due to data errors or denied altogether. Incorrect billing codes, errant or missing client information, and failing to follow an insurer’s policies can all result in rejections or denials. To avoid these scenarios, experts recommend strategies including working with coding service providers who can double-check the accuracy of the codes you enter on your claim forms, having clients verify their personal information during each visit, and staying in touch with insurers to ensure you have access to the most up-to-date policy information.

Insurance pre-authorizations

Some insurers require prior authorization before a client can utilize certain mental healthcare services or medications. Understanding what an insurer’s policies are will help you avoid any holdups in your client’s treatment while also making sure you’re compensated for your work. Failing to obtain pre-authorization when it’s required by an insurer could result in a denied claim.

Out-of-network vs. in-network billing

You can use in-network billing when you’re credentialed with a client’s insurer. Out-of-network billing, on the other hand, occurs when you’re not credentialed with the client’s insurance company (although some insurers do offer out-of-network coverage options). Out-of-network billing can result in lower reimbursement rates, so it’s helpful to know what your client’s coverage situation is upfront.

A guide to billing insurance as a psychiatrist

Ready to begin billing for your services? Here’s the process you’ll need to follow.

Get credentialed with providers.

Before you can start billing insurance companies, you’ll need to join insurance panels. Once you identify the insurance panels you want to join, you must get individually credentialed with each one. This will essentially involve submitting a variety of information about yourself and your practice, from your NPI number and license details to proof of your liability insurance and professional references. Keep in mind that most commercial insurance carriers require their providers to have an account with the Council for Affordable Quality Healthcare (CAQH) to get credentialed. Headway partners with CAQH to make the process as smooth as possible.

Verify your client’s insurance and benefits.

Once you’re paneled, you’ll work with clients to determine their coverage. Many insurance companies have online programs or software that make it easier to look up a client’s plan before you bill. Note that some plans also only cover a certain number of therapy sessions, or types of therapy, which is important to tell the client.

Headway takes care of verification for you. We verify client demographic information prior to claims filing, based on what the client enters for their insurance information. We always ensure that the client's name, date of birth, and insurance member ID matches the information their insurer has on file.

Properly document sessions and assign correct codes.

Make sure you take detailed notes on each session and your treatment plan so you can assign the correct billing codes when it comes time to submit a claim. These notes — particularly details that speak to why your client needs whatever service you’re providing — are also important to have on file in the event you need to file an appeal for a denied claim. Here are some commonly used CPT psychiatry codes and how they come into play:

90792 – Psychiatric Diagnostic Evaluation With Medical Services: The most common code used for intake appointments, 90792 represents a mental health appointment that involves an evaluation and diagnosis, along with medical services (which include an exam, prescribing, or evaluating existing medication).
99213 & 99214 – Established Patient Office or Other Outpatient Visit: Code 99213 represents an E/M appointment with an established patient lasting 20-29 minutes. Similarly, code 99214 represents an E/M appointment with an established patient lasting 30-39 minutes.
90833 – Evaluation and Management with 30 Minutes Psychotherapy: An add-on code that can be used with an E/M code, code 90833 represents an E/M appointment with 16-37 minutes of psychotherapy.

Submit claims.

If you don’t use a service like Headway for billing, you’ll probably use the insurance provider’s program or software to create and submit claims. Typically, you can opt to receive payment via paper checks or electronic funds transfer, but payment schedules will vary by provider. Some may pay you weekly, for instance, while others may deposit payments monthly. Have a denied claim? Review it closely as soon as you’re able, experts advise, and check the insurer’s policy to find out how long you have to resubmit the claim.

Billing and coding