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How and When to Use the 99284 CPT Code

Mistakes in medical billing codes are one of the most common reasons that claims get denied by mental and behavioral health payers. The overall memorization and correct application of CPT codes is part of what makes insurance billing so complicated. The ability to use these codes in the correct context plays a part in how providers can increase clean claims and improve their revenue cycle. With so many different CPT codes, it can be difficult to know exactly when to apply each one.

A consequence of incorrect coding is the forfeiting of reimbursements. Insurance companies look for any and every opportunity to deny a provider’s claim for reimbursement. For this reason, providers need to find ways to perfect their claims process and minimize denials. 

A clean claim is one that is approved after its first submission. This is the ideal scenario for any provider working with insurance because it means they will get paid in a timely manner and optimize their insurance billing process. CPT codes play a huge role in the percentage of clean claims that a provider submits. 

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.  

The good news is that there are ways providers can perfect their coding and claims process to optimize their clean claims. One of the most used codes for mental health providers is code is 99284, when and how to use it, and what tools you can use to improve your claims process. 

99284 CPT Code Description and Use

The 99284 CPT code is one part of a set of codes used to describe emergency department visits for the evaluation and management of a patient. This code is defined in the official CPT manual as :

Emergency department visit for the evaluation and management of a patient, which requires these 3 key components:

  • Component 1: A detailed history
  • Component 2: A detailed examination
  • Component 3: Medical decision making of moderate complexity

Counselling and/or coordination of care with other physicians, other qualified health care professionals, 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 high severity, and require urgent evaluation by the physician, or other qualified health care professionals but do not pose an immediate significant threat to life or physiologic function.”

The other codes in this set vary based on the detail in the history collected, the detail in the examination, and the level/complexity of decision making. The other codes include: 

CPT Code 99281

  • Problem Focused History
  • Problem Focused Examination
  • Straightforward Medical Decision Making 
  • Presenting Problem Is Usually Minor

CPT Code 99282

  • Expanded Problem Focused History
  • Expanded Problem Focused Examination
  • Medical Decision Making of Low Complexity
  • Problem is Usually Low Severity 

CPT Code 99283

  • Expanded Problem Focused History
  • Expanded Problem Focused Examination
  • Medical Decision Making of Moderate Complexity 
  • Problem is Usually Moderate Severity

CPT Code 99285

Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient’s clinical condition and/or mental status:

  • Comprehensive History 
  • Comprehensive Examination 
  • Medical Decision Making of High Complexity 
  • Problem is Usually of High Severity/Poses Immediate/Significant Threat to Life or Physiologic Function

How to Improve Mental Health Billing

The most effective way to improve your use of the 99284 CPT code and improve your coding/claims process overall is to utilize electronic mental health billing software. Quality technology can revolutionize how your organization approaches its claim process, improving clean claims and securing 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 to worry less about billing and coding the 99284 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. 

MyClientsPlus may be well known for its simple practice management software and stellar customer support, but we also provide managed billing services

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