15 Nov Reimbursement Rates Discussion 2 Reimbursement Rates Discussion 2 Reimbursement rates and medical coding can be almost as complicated as treating some mental il
Reimbursement Rates Discussion 2
Reimbursement Rates Discussion 2
Reimbursement rates and medical coding can be almost as complicated as treating some mental illnesses. As a Psychiatric-mental health nurse practitioner (PMHNP), you will be faced with varying rates that may be different than other health care providers you may work with.
In this Practicum Journal Assignment, you will analyze reimbursement rates for mental health treatments you will likely use in your practice and compare those rates to other provider rates.
Learning Objectives
Students will:
· Analyze reimbursement rates for mental health treatments
Assignment
· Research reimbursement rates for various treatment modalities.
· Compare PMHNP rates to other medical provider rates.
· For this Practicum Journal:
Complete the Reimbursement Rate Template in your Learning Resources using
the five types of services you are likely to use in your practice. (PLEASE USE THE
Attached Reimbursement Rate Template)
N.B: (1) REMEMBER TO INCLUDE INTRODUCTION, CONCLUSION AND
REFERENCES LESS THAN 5 YEARS OLD
(2) PLEASE USE THE Attached Reimbursement Rate Template
As the PMHNP becomes proficient in diagnosing and treating, it is also important to learn how to bill for your time. The CMS sets up codes to identify the type of service you are providing. You will generally complete this task at the end of the visit as you are documenting the visit with the client. Here are examples of the codes to know: Reimbursement Rates Discussion 2
CPT Codes for Psychiatric and Psychological Procedures
HMSA recognizes the following service codes for the reporting of psychiatric and psychological services. (See Code Books for information on how to obtain the books.)
| CPT Code | Footnote(s) | Description |
| 90791 | 1 | Psychiatric diagnostic evaluation |
| 90792 | 1,3 | Psychiatric diagnostic evaluation with medical services |
| 90832 | 2 | Psychotherapy, 30 minutes with patient and/or family member |
| 90833 | 2,3 | Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service |
| 90834 | 4 | Psychotherapy, 45 minutes with patient and/or family member |
| 90836 | 3,4 | Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service |
| 90837 | 6 | Psychotherapy, 60 minutes with patient and/or family member |
| 90838 | 3,6 | Psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service |
| 90839 | 6 | Psychotherapy for crisis; first 60 minutes |
| 90840 | 2 | each additional 30 minutes |
| 90846 | 4 | Family psychotherapy (without the patient present) |
| 90847 | 4 | Family psychotherapy (conjoint psychotherapy) (with patient present) |
| 90849 | 4 | Multiple-family group psychotherapy |
| 90853 | 4 | Group psychotherapy (other than of a multiple-family group) |
| 90870 | 1, 5 | Electroconvulsive therapy (includes necessary monitoring) |
| 96101 | 1 | Psychological testing (includes psychodiagnostic assessment of personality, psychopathology, emotionality, intellectual abilities, e.g., WAIS-R, Rorschach, MMPI) with interpretation and report, per hour.
Note: All hours of psychological testing done on a single day will be counted as one visit (either inpatient or outpatient as appropriate) toward the patient’s inpatient or outpatient visit maximum. However, payment will be made to the participating provider on a per-hour basis. |
| 96118 | 1 | Neuropsychological testing battery (e.g., Halstead-Reitan, Luria, WAIS-R) with interpretation and report, per hour
Note: All hours of psychological testing done on a single day will be counted as one visit (either inpatient or outpatient as appropriate) toward the patient’s inpatient or outpatient visit maximum. However, payment will be made to the participating provider on a per-hour basis. |
Links to websites that discuss this:
http://www.mb-guide.org/medical-coding-guidelines.html
NURS 6670
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