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New CPT Codes Went Into Effect on January 1

(Written by Jay Hale, Director of Quality Improvement & Clinical Operations)

The American Medical Association made significant changes to the Current Procedural Terminology (CPT) that became effective January 1, 2013.  The new system removes most of the CPT codes used by behavioral health practitioners and substitutes Evaluation and Management (E/M) codes, new CPT codes and a new concept called “add on” codes for most former codes used to describe psychiatric care.  As CBHA providers continue to file claims using the new system, here are things to consider:

Add-on codes are descriptors of a service that is done in conjunction with another service or a descriptor of the complexity of a specific service.  These codes are used either in conjunction with E/M codes or with certain CPT codes to describe the services provided to the member during an office visit.  There should be appropriate documentation in the member’s file that not only supports the main service, but also services described by the add-on code.  The add-on code should always be filed on the same claim form as the service to which it is attached.  Filing an add-on code on a separate claim form will cause the claim to be returned to you for correction.

The new coding system removed the 90808 (75-80 minutes) from the set of coding options.  The extended session is now described as up to 60 minutes (90837).  This code would typically be used for extended sessions beyond the typical 45-50 minute session (90834) and would most likely be implemented when a therapist needs to provide an evidence based intervention, such as EMDR or Exposure Therapy, that take longer than the standard session.  CBHA expects that most on-going psychotherapy will be billed as a standard session-90834 and created the new fee schedule for 2013 to reflect this.

There is a new CPT code called “Psychotherapy for Crisis.”  This code is used to describe services that include “an urgent assessment and history of a crisis state, a mental status exam and a disposition.” (CPT Professional Edition, 2013)  The code is to be used when there is face-to-face time with a client who presents with a problem that is “life threatening or complex and requires immediate attention to a patient in high distress.”  Per the latest guidelines from the AMA (from the CPT Professional Edition, 2013), the code is used to report “the first 30-74 minutes of psychotherapy for crisis on a given date….Code 90840 is used to report additional block(s) of time, of up to 30 minutes each beyond the first 74 minutes.”

Please keep this in mind as you bill for services rendered to CBHA members.  If you have any questions, please call CBHA at (800) 475-7900.

Provider Hall of Fame

CBHA regularly distributes “Enrollee Satisfaction Surveys” to randomly selected members, offering them a chance to provide feedback on the services they received from both CBHA and its panel.  This section of our newsletter serves as a forum in which we like to acknowledge any providers who were identified as providing outstanding service to our clients.   

Since the distribution of our Fall 2012 newsletter, we had several providers recognized by members.  They include: 

  • Cristin Whiting, PsyD, of Winston-Salem -- A member stated, “Dr. Whiting has been excellent…and continues to help me maintain a healthy life balance.”  A second member also recognized Dr. Whiting:  “I was fortunate to be referred to [her].  She is both competent and caring.  I have achieved a great breakthrough under her care.”
  • Jill Eilenberger, LMFT, LCSW, of Charlotte, NC, was described as “a consummate professional who provided information for aftercare as well.  She is caring, compassionate and knowledgeable.  I would highly recommend her.”
  • A member was “very grateful for the [behavioral health] benefit and the care received from Michael Hayes, LPC,” of Winston-Salem, NC. 
  • Fred Caudill, MD, in Matthews, NC --  A member stated, “I have done so well with Dr. Caudill.  I am extremely pleased with him as my mental health provider.” 
  • “I am very happy with the treatment I receive,” was a declaration regarding Margaret “Peggy” Fergus, LCSW, of Winston-Salem. 
  • “Kris Grapes is exceptional,” commented a member who sees Kristin Grapes, PhD, in Winston-Salem. 
  • Misty Collier, LPA, of Huntersville, NC, “is worth her weight in gold!!  She is excellent!  A very knowledgeable counselor.  Great help.”   A second member also recognized Ms. Collier, stating, “Misty Collier is awesome!!”  
  • One satisfaction survey recognized two providers.  “Dr. Kris Grapes is excellent.  So is Dr. Bruce Rau,” [MD of Winston-Salem].

Overall, the “Enrollee Satisfaction Surveys” were positive and members are satisfied with the services provided by CBHA and its provider panel.  Thank you to everyone for the outstanding care you administer to our members!

Behavioral Health Quality Improvement Committee for CBHA

The Behavioral Health Quality Improvement Committee (BQIC) provides oversight of our network, by our network.  Members commit to a three-year term, meeting on the third Wednesday of every other month.  Dr. James Kimball, CBHA Medical Director, serves as the Chairman of this committee. 

CBHA would like to recognize the members of our provider panel that so willingly give of their time to serve on BQIC.  These providers meet six times per year at the CBHA office to review our quality improvement indicators, as well as oversee the credentialing process of our network.  The BQIC panel currently consists of:  

James Kimball, MD
Gretchen Brenes, PhD
Christopher Aiken, MD
Laurel Link, LPC
Carole Collins, LPC
Timothy King, MD
Richard Martin, LPC
Stephen McCullough, PsyD

CBHA appreciates the aforementioned providers for their contributions to our ongoing quality-improvement process.  Additionally, their input is beneficial in assuring appropriate provider credentialing and network adequacy. 

We would like to take a moment to recognize and thank Patti Patridge, LPC, for her time served on BQIC.  She recently had to rotate off the committee, because she completed her three-year term.  At our last meeting, she was presented with a certificate of recognition for her service.  Thank you, Ms. Patridge, for your time, dedication and welcomed input during your tenure.

Is your client in need of admission to an intensive level of care?

There are times when a CBHA member may come to you for outpatient services, and it becomes apparent they are in need of an inpatient setting, partial hospitalization or an intensive outpatient program.  Clients need assurance their admission to these services is as seamless as possible.  A factor to consider is that not all facilities within your area may be in-network with CBHA.     

If you find yourself in a situation where a CBHA client needs an intensive level of care, please, remember case managers are available to assist you with locating an in-network facility.  Call 1-800-475-7900 for assistance with identifying facilities for your CBHA client, or, access our website, www.cbhallc.com and click on “Provider Search” at the top of the page.  Under “Search by Specialty,” click on the down-arrow and choose “facility” for a list of CBHA options in your area.

Frequently Asked Questions

1.  What services require pre-registration?

All services require pre-registration.  This includes:  outpatient therapy and medication management sessions; psychological and neuropsychological testing; EMDR; outpatient consultations; ECT (both outpatient and inpatient); behavioral health home visits; outpatient Suboxone treatment; Gastric Bypass Evaluations and Vagus Nerve Stimulators (VNS).  Additionally, all intensive levels of services (i.e., inpatient, partial and intensive outpatient programs) must be pre-registered.  Please, call, 1-800-475-7900 to speak with a clinical case manager to obtain registration for these services.  

2.  How do I obtain registration for psychological and/or neuropsychological testing?

If there is not a registration for outpatient services already in place, call CBHA to obtain authorization for consult visits so an evaluation can be done in order to determine what type of testing will be necessary.  Prior to administering any testing, the provider should access the CBHA website, www.chballc.com, and obtain a copy of the “Psych Testing Request” form which can be located by clicking on, “Providers,” then “Provider Forms.”  The form should then be submitted via fax (888-908-7140), or via mail (PO Box 571137, Winston-Salem, NC 27157). 
Upon receipt of the testing request form, a clinical case manager submits it to our consulting psychologist for review, and the psychologist renders a decision to the CCM within three business days of the request.  Most requests for testing are granted based upon a need to clarify a clinical issue or a need to provide direction for treatment planning.  Please, keep in mind, testing for Learning and Developmental Disabilities are generally not eligible under the behavioral health plan; call to obtain details of specific health plans managed by CBHA.   

3.  What is the process for registering outpatient sessions?

For initial outpatient services, CBHA registers 20 sessions for psychotherapy within a 12-month period.  For example, if you call on 4/16/2013 to obtain a registration for outpatient sessions, that registration would be active until 4/16/2014.  For medication management visits, the initial registration is open-ended, meaning there is no limit to the number of sessions and there is no expiration date.  It is valid for as long as you are performing medication management.
CBHA registers the services for in-network providers in order to promote coordination of care among treating providers, as well as, to assure the patient is not receiving concurrent care by two like-providers.  Call CBHA at 1-800-475-7900 to obtain a registration of care. 

4.  What if I need more psychotherapy sessions beyond the initial 20?

In order to request more psychotherapy sessions after the initial 20, you will need to access the CBHA website and obtain a copy of the “Outpatient Services Review” form and submit it, either via fax or mail.  The form will be reviewed by a CCM to ascertain the clinical issues that support additional psychotherapy sessions, as well as review for the projected conclusion of therapy.

5.  Is group therapy covered under an outpatient psychotherapy registration?

Yes, registered visits cover individual as well as group therapy sessions provided by the registered therapist. CBHA will not pay for support groups provided by non-licensed therapists.

6.  Can a patient see his/her therapist and psychiatrist in the same day?

An enrollee may see his/her therapist and psychiatrist in the same day and receive insurance reimbursement if both providers have prior registration.

7.  If a network provider fails to obtain registration prior to providing treatment, will CBHA backdate that registration?

CBHA will not backdate if pre-registration is not obtained prior to the provision of services.  Please, remember, the patient can not be held liable for the payment of services for lack of registration; enrollees are only responsible for their co-pay or coinsurance.  If you have a case where you were unable to obtain pre-registration due to extenuating circumstances, call CBHA to discuss the issue.  Please, note, CBHA does allow a five business-day grace period to obtain registration for outpatient therapy and medication management visits.

Friendly Reminder

It is imperative you review your client’s insurance card at each session so you may be aware of any possible changes to his/her behavioral health insurance.  We provide behavioral health coverage for a niche of the MedCost and Blue Cross Blue Shield populations--among others--so, please, thoroughly review both sides of the card to ensure you submit claims to the correct insurance company. 

If a member’s claims administration is contracted through CBHA, this information will typically be on the back of the insurance card.  If this is overlooked, it could ultimately lead to delayed reimbursement for your services.  In the most extreme case, it could even mean you miss our timely-filing deadline, and rendered services would not be eligible for payment.

About CBHA

We are a provider-owned managed behavioral health organization dedicated to quality behavioral health care.  CBHA strives to ensure that enrollees receive quality care, that providers have the resources to provide this care and that the benefit is used effectively and efficiently.  Being owned by three not-for-profit medical schools (East Carolina University, University of North Carolina at Chapel Hill and Wake Forest University) enables CBHA to provide quality services at a competitive rate.  Our relationship to the academic medical centers is aimed at improving the delivery of behavioral health services to the citizens of North Carolina and parts of both South Carolina and Virginia through research and education.  Ultimately, our motto is “to do the right thing for the right reason.”