Ia there a code that can be used to consult with other professionals about clients and/or a code that can be used to bill a consult with a client who is in residential tx?
Customer support service by UserEcho
Customer support service by UserEcho
If the client is under 21, you can use code 90899 for consults with other professionals.
So is this a code that covers phone calls with other professionals (such as therapists, psych nurses)?
But, a lot of private/commercial payers won't pay the 90899 - just so you know.
I just got paid from HealthPartners PMAP and BCBS on the code.
BCBS is the only private/commercial plan we've been paid by. PMAP's generally pay us for that code, but sometimes ask for documentation.
Good to know. For us, HP PMAP paid without requesting documentation. BC requested the progress note.
Is this only for under age 21 or can this code be used for adults?
only under 21
Although I did bill one for over 21 and was paid for it by PMAP.
Im not seeing the code with modifiers listed as available in the pick list for us (on a kiddo) Do you have to be a specific type of clinic, behavioral health with DHS? or can any clinic bill this code? How do we get the codes?
We entered the code into our Procentive information, when it became available. You might want to check with your billing department.
You have to add the codes your self. This is a code that requires a "narrative description". Most common is "Care Coordination". You have to go into the Payer's module, under rates>codes and add it there. Here is my info sheet on the code that I made from info in the MHCP provider manual;
Clinical Care Consultation Code- 90899
90899 U8 Face to Face 5-10 mn
90899 U9 Face to Face 11-20 mn
90899 UB Face to Face 21-30 mn
90899 UC Face to Face 31 mn plus
90899 U8U4 Telephone 5-10 mn
90899 U9U4 Telephone 11-20 mn
90899 UBU4 Telephone 21-30 mn
90899 UCU4 Telephone 31 mn plus
Mental health clinical care consultation is communication via phone or face-to-face between a treating mental health professional and other providers or educators who are working with the same recipient. These professionals use the consultation to discuss issues about the recipients symptoms, strategies for effective engagement, care and intervention needs, treatment expectations across service settings and/or clinical service components provided to the recipient and family.
- Age 21 and under
- MA requires a dx of mental illness determined by a DA that meets the definition of complex or co-occurs with other complex and chronic health conditions and requires consultation to other providers working with the child to effectively treat the condition. Complex needs are those caused by disruptive or changing environments, the need to consider past dx's and determine their current applicability, cognitive or neurocognitve impairment, co-occuring substance abuse use disorder, acuity of psychotic disorder, communication barriers or cultural considerations.
Examples of appropriate providers and educators who may receive consultation are home health care agencies, child care providers, mental health case managers, educators, probation agents, adoption or guardianship workers, guardians ad litem, child protection workers, pediatricians, nurses, after-school program staff and mentors. In sum, anyone except parents or legal guardians.
Document every consultation in a progress note which includes the following:
- Mode of performance (phone or face-face)
- Start and stop time
- Person consulted (name, position, relationship to recipient)
- Narrative description: reason for consultation and what was discussed
MA requires additional documentation of medical necessity in the DA or a DA Addendum or within the narrative portion of the treatment plan review process. In the Treatment Plan document the specific interventions, describing how the mental health professionals will use the mental health clinical care consultation to treat the child's mental illness. The progress note must also note a plan and action for next steps.
What code would you use for adults?
I don't know that there is a code for adults.