One of the most difficult parts of mental health insurance billing is the memorization and correct application of CPT codes. Knowing when to use the right one and in what situation is how providers secure an approved claim and earn their reimbursement from each payer they work with. With so many different CPT codes, it can be difficult to know exactly when to apply each one. Errors in billing codes are one of the top reasons for denied claims in the industry, so it is important that providers have a strong grasp on their use.
If they code a claim incorrectly, they will forfeit their time and possibly their reimbursement unless they were to quickly correct and resubmit that claim in hopes it will be approved the second time.
The goal of any mental health provider, when it comes to billing, is to improve their claims process so they can avoid denials as much as possible. This would mean that they are increasing the number of clean claims they submit, or claims that get approved after their very first submission.
CPT stands for Current Procedural Terminology and is used to reflect testing, procedures, evaluations, and other services provided to a client or patient in the healthcare, mental, and behavioral health fields.
One of the most used codes for mental health providers is code is 99202. Keep reading to learn about CPT code 99202 and why to use it.
What is CPT Code 99202?
CPT Code 99202 is one part of a set of codes used to describe E/M New Patient Office Visits. This code specifically is an E/M New Patient Office Visit that lasts 20 minutes. The official definition of this code according to the CPT manual is as follows:
Office or other outpatient visit for the evaluation and management of a new patient which requires these 3 components:
Component 1: An expanded problem focused history
Component 2: An expanded problem focused examination
Component 3: Straightforward medical decision making
Counselling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of low to moderate severity.”
Other codes in this set include:
99201 – E/M New Patient Office Visit Lasting 10 Minutes.
99203 – E/M New Patient Office Visit Lasting 30 Minutes
99204 – E/M New Patient Office Visit Lasting 45 Minutes
99205 – E/M New Patient Office Visit Lasting 60 Minutes
How and When to Use the 99202 CPT Code
For psychiatrists that provide E/M new patient services, the level of decision-making will determine when you use this code. At higher levels of clinical decision-making, you might need to use a different code than the 99202 CPT code.
According to the American Psychiatric Association, “when billing outpatient E/M on the basis of time, psychiatrists may now use the total time on the date of the service related to the patient encounter, not just the face-to-face time. This includes:
- Preparing to see the patient (e.g., review of test, records)
- Obtaining and/or reviewing the separately obtained history
- Performing a medically necessary exam and/or evaluation
- Counseling and educating the patient/family/caregiver
- Ordering medications, tests, or procedures
- Referring and communicating with other healthcare professionals (when not reported separately)
- Documenting clinical information in the electronic or paper health record
- Independently interpreting results of tests/labs and communication of results to the family or caregiver
- Care coordination (when not reported separately)”
How to Improve Your Coding Process
The most effective way to improve your use of the 99202 CPT code and improve your coding/claims process overall is to utilize electronic mental health billing software. The right software can help you navigate the coding process so that you can increase clean claims and boost your bottom line.
A quality billing solution offers the following features and benefits:
- Electronically bill primary/secondary insurances
- Bill out-of-network
- Easily check claim status
- Track client and insurance payments
- Track Insurance Authorizations
- All-in-one system that allows you to process client payments directly in your account.
- And More.
You deserve to have worry less about billing and coding the 99202 CPT code correctly. Utilizing billing technology can remove the pressure of coding correctly while streamlining your entire billing process and allowing you to focus more on your clients/patients. Learn more about managed billing services from the MyClientsPlus team by scheduling a call. Fill out the form below.