Know The Difference Between Mental Health and General Medical Coding Systems
In spite of the misconceptions, mental health and medical billing have important distinctions. Both the specialties have a coding system that is unique to each other. It is important for providers in both the fields to have an understanding of these differences. Without proper knowledge, billing and coding professionals will not be able to process the claims well. This eventually leads to denials, rejections, delayed payments, and hampered revenue cycle.
What is Mental Health Billing and Medical Billing?
Mental health billing is the process of filing and monitoring claims for mental health and behavioral services, treatments, etc. Includes psychotherapy, counselling, psychiatric examinations, medication management, crisis intervention services, virtual session and other behavioral health services. Behavioral health billing also covers individual, group, and family therapy sessions. Mental health billing has its own set of codes and guidelines to be referred to. This is because it is a completely different type of billing category as compared to other specialties’ billing and coding.
Medical billing, in contrast, deals with claims for basic to advanced healthcare services. This includes consultation, operations, surgeries, procedures, treatments, medication prescriptions, chronic disease management, preventive care services, and follow-ups. Medical billing heavily relies on codes, documentation, and schedules common in many healthcare specialties- from dermatology to cardiology.
What Does The Umbrella Term “Mental Health And Behavioral Billing” Entail?
Divided further into four major billing categories, mental health and behavioral billing includes:
1) Psychiatric Billing: Sharing more similarities with medical professionals as compared to any other mental healthcare providers, psychiatrists are required to have deeper insight about the mental health coding. They are not only using the mental health CPT codes but will also need to be familiar with diagnostic evaluation codes. Both of these are used for billing processes.
2) Psychotherapist Billing: Medical billing software is usually not equipped to undertake the behavioral and mental health billing tasks. Some medical programs also do not consider the intricate nature of mental health billing, the sessions, or residential or the in-patient stays. Therapists use common psychotherapy codes, CPT codes that describe a specific duration of time for each session, crisis codes, testing and assessment coding, and other add-on codes, depending on the patient case.
3) Behavioral Health Billing: Similar to psychotherapy billing, behavioral health billing has one difference- relating to social services and other forms of behavioral health- working with a community social worker. Behavioral health billing includes services rendered when working with a behavioral specialist. An example of this is Applied Behavior Analyst.
4) Facility Detox Billing (Substance Abuse): Because of the complicated circumstances they work in, substance abuse facilities have their own type of billing. Changing industry laws, regulations, and issues that arise with insurance companies make substance abuse billing tricky. Inpatient facilities have their own coding about which medical billers need to be aware of. The ICD-10 coding system has various billing codes for substance use and behavioral health treatment. Staying up-to-date with these is important to have a successful billing cycle.
How Is Mental Health and General Medical Coding System Different?
Differing in the types of codes, services they code, the codes used and the billing processes involved, mental health and general medical coding systems are at a contrast from each other.
Key Area
Mental Health Billing
Medical Billing
Coding System
Mental health and behavioral health uses DSM-5 codes for diagnoses, along with the ICD-10 coding system
Medical billing relies heavily on ICD-10 codes for diagnoses and CPT codes.
Time-based Billing
Mental and behavioral services are billed based on the time taken for the services to render. For instance, 30-minutes, 45-minutes, 60-minutes.
Medical billing uses procedure-based codes that are not time-bound.
Preauthorization Requirement
Here, the services often required preauthorization from insurance companies, even for routine outpatient care.
Preauthorization is typically reserved in medical billing for specialized procedures or treatment
Coverage Limit
Mental health benefits usually have different coverage limits. Example- Annual limits on the number of therapy sessions that will be covered
Coverage limits include sub-limits, allowed amounts and time limits.
Provider Types
Mental and behavioral health billing has a wider range of provider types- psychiatrists, psychologists, licensed clinical social workers, and counselors.
Medical billing includes physicians, nurse practitioners, specialists, other clinical staff, and health professionals.
Privacy Consideration
Because of the sensitive nature of mental health treatment, the billing for the same must comply with the stricter privacy regulations- 42 CFR Part 2 for substance abuse treatment records and HIPAA.
Subject to general healthcare laws and regulations.
Bundled Services
Intensive outpatient or residential treatment settings often come in bundled services. This calls for specific coding and billing practices differing from the typical medical outpatient services.
Covers physical health services and uses a single CPT code for multiple procedures performed at the same time.
Services rendered
Psychotherapy, counselling, psychiatric evaluation, medical management, substance abuse, and behavioral health.
Diagnosis, treatment, surgery, medication.
Reimbursement Rates
Rates vary and are usually lower as compared to medical services because of insurance limitations.
Generally higher reimbursement rates as compared to mental health services.
Billing Complexity
Is more complex due to the requirement of thorough documentation and compliance with the regulations.
Billing is simpler due to standardized procedures and an established medical coding system
Despite the many differences between the two, mental health billing and medical billing share similarities
Common Codes in Mental Health Billing and Medical Billing
Mental Health Billing uses DSM-5 and ICD-10 codes for diagnosis.
- Anxiety : ICD-10 code F41.9 for Anxiety Disorder, Unspecified
- Depression : ICD-10 code F32.9 for Major Depressive Disorder Unspecified
- PTSD : ICD-10 code F43.10 for Post-Traumatic Stress Disorder
These codes are usually time-based as mental health services are billed depending on the session duration.
Medical Billing uses ICD-10 codes for diagnosis and CPOT codes for services rendered.
- Hypertension : ICD-10 code I10 for Essential Hypertension
- Routine Visit : CPT code 99203 for Office Visit, Moderate Complexity
- Surgery : CPT code 47562 for Laparoscopic Cholecystectomy
Understanding the differences between mental health billing and general medical billing systems is important . This goes equally for both providers as well as billing professionals. While both fields rely heavily on coding systems to ensure that claims are processed effectively, they have varied processes, requirements, and coding structures.
Mental health usually involves time-based billing, specific privacy regulations, and a wider variety of provider types. In case of medical billing, there tends to follow more standardized procedures. Recognizing these differences prevents issues of claim denials and payment delays, making way for smoother revenue cycles and compliance with industry regulations.
By staying informed on both the unique and shared aspects of mental health and medical billing, professionals can enhance the accuracy of their work and improve outcomes for both patients and healthcare providers. Taking help from the expert medical billing and coding services providers is a great way to deal with billing complexities with ease. Instapay Healthcare Services takes care of the complicated billing nature of mental health as well as general medical. Better your practice as the revenue of your practice is in safe hands!
