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Coding and Payment Guide for Behavioral Health Services Procedure Codes 80100-80101 [80104] 304.42 80100 Drug screen, qualitative; multiple drug classes chromatographic method, each procedure 80101 single drug class method (eg, immunoassay, enzyme assay), each drug class 80104 multiple drug classes other than chromatographic method, each procedure Explanation This test may be requested as a drug screen for multiple drug classes. The screening test must be performed by a chromatographic technique that has good sensitivity, although it may not be as specific as a confirmatory test. Thin-layer chromatography is a common chromatographic technique for drug screening tests. It is performed by applying a thin layer adsorbent to a rectangular plate in the stationary phase. The specimen is applied to the plate and the end of the plate is placed in a solvent. As the solvent rises along the adsorbent on the plate, the different components of the specimen are carried along at varying rates and deposited along the plate. The different components can be separately visualized and analyzed. Positive tests are always confirmed with a second method. Specimen type varies. Coding Tips Code 80104 is a resequenced code and will not display in numeric order. Refer to codes in the Chemistry section (82000-84999) or the Therapeutic Drug Assay section of the CPT book for quantitation of drugs screened (80150-80299). To report the professional services for drug management, see HCPCS Level II code M0064, CPT code 90683, the appropriate level of E/M service, or the appropriate psychotherapy with E/M service code. Follow third-party payer guidelines when selecting the appropriate code for these services. If a specimen is transported to an outside laboratory, report 99000 for handling or conveyance. These codes represent a CLIA-waived test. ICD-9-CM Diagnostic Codes 304.00 304.01 304.02 304.10 304.11 304.12 304.20 304.21 304.22 304.30 304.31 304.32 304.40 304.41 Opioid type dependence, unspecified Opioid type dependence, continuous Opioid type dependence, episodic Sedative, hypnotic or anxiolytic dependence, unspecified Sedative, hypnotic or anxiolytic dependence, continuous Sedative, hypnotic or anxiolytic dependence, episodic Cocaine dependence, unspecified Cocaine dependence, continuous Cocaine dependence, episodic Cannabis dependence, unspecified Cannabis dependence, continuous Cannabis dependence, episodic Amphetamine and other psychostimulant dependence, unspecified Amphetamine and other psychostimulant dependence, continuous Work Value 80100........................ 0.00 80101........................ 0.00 80104........................ 0.00 © 2014 OptumInsight, Inc. 304.51 304.52 304.61 304.62 304.71 304.72 304.81 304.82 305.21 305.22 305.31 305.32 305.41 305.42 305.51 305.52 305.61 305.62 305.71 305.72 305.81 305.82 Amphetamine and other psychostimulant dependence, episodic Hallucinogen dependence, continuous Hallucinogen dependence, episodic Other specified drug dependence, continuous Other specified drug dependence, episodic Combinations of opioid type drug with any other drug dependence, continuous Combinations of opioid type drug with any other drug dependence, episodic Combinations of drug dependence excluding opioid type drug, continuous Combinations of drug dependence excluding opioid type drug, episodic Nondependent cannabis abuse, continuous Nondependent cannabis abuse, episodic Nondependent hallucinogen abuse, continuous Nondependent hallucinogen abuse, episodic Nondependent sedative hypnotic or anxiolytic abuse, continuous Nondependent sedative, hypnotic or anxiolytic abuse, episodic Nondependent opioid abuse, continuous Nondependent opioid abuse, episodic Nondependent cocaine abuse, continuous Nondependent cocaine abuse, episodic Nondependent amphetamine or related acting sympathomimetic abuse, continuous Nondependent amphetamine or related acting sympathomimetic abuse, episodic Nondependent antidepressant type abuse, continuous Nondependent antidepressant type abuse, episodic Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. IOM References 100-4,16,70.8 CCI Version 20.0 80500-80502 Also not with 80100: 80101, 82486-82489, G0431v Also not with 80101: 83516-83518, G0431v Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 CPT © 2014 American Medical Association. All Rights Reserved. 87 Procedure Codes Coding and Payment Guide for Behavioral Health Services 80102 80102 304.70 304.71 Drug confirmation, each procedure 304.72 Explanation This test may be requested as drug screen confirmation. It is performed when the initial drug screen (80100-80101) is positive. Confirmatory tests must be both sensitive and specific and involve a different technique than the initial screen. For example, if the initial screen is performed by thin layer chromatography identifying a spot on the chromatogram that is the right color and in the right place to be consistent with a particular drug, it is confirmed with a more specific method, like high performance liquid chromatography (HPLC), gas chromatography-mass spectrometry (GC-MS), or immunoassay. If the drug suspected is a barbiturate, for example, a confirmatory HPLC method might be done to prove that the compound had the correct retention time, etc., and to identify it exactly as a particular barbiturate. 304.80 304.81 305.21 305.22 305.31 305.32 305.41 Coding Tips 305.42 Refer to codes in the Chemistry section (82000-84999) or the Therapeutic Drug Assay section of the CPT book for quantitation of drugs screened (80150-80299). Report 80102 for each procedure necessary for confirmation. To report the professional services for drug management, see HCPCS Level II code M0064, CPT code 90863, the appropriate level of E/M service, or the appropriate psychotherapy with E/M service code. Follow third-party payer guidelines when selecting the appropriate code for these services. If a specimen is transported to an outside laboratory, report 99000 for handling or conveyance. 305.51 305.52 305.61 305.62 305.71 ICD-9-CM Diagnostic Codes 305.81 305.82 304.00 304.01 304.02 304.10 304.11 304.12 304.20 304.21 304.22 304.30 304.31 304.32 304.40 304.41 304.42 304.50 304.51 304.52 Opioid type dependence, unspecified Opioid type dependence, continuous Opioid type dependence, episodic Sedative, hypnotic or anxiolytic dependence, unspecified Sedative, hypnotic or anxiolytic dependence, continuous Sedative, hypnotic or anxiolytic dependence, episodic Cocaine dependence, unspecified Cocaine dependence, continuous Cocaine dependence, episodic Cannabis dependence, unspecified Cannabis dependence, continuous Cannabis dependence, episodic Amphetamine and other psychostimulant dependence, unspecified Amphetamine and other psychostimulant dependence, continuous Amphetamine and other psychostimulant dependence, episodic Hallucinogen dependence, unspecified Hallucinogen dependence, continuous Hallucinogen dependence, episodic Work Value 305.72 Combinations of opioid type drug with any other drug dependence, unspecified Combinations of opioid type drug with any other drug dependence, continuous Combinations of opioid type drug with any other drug dependence, episodic Combinations of drug dependence excluding opioid type drug, unspecified Combinations of drug dependence excluding opioid type drug, continuous Nondependent cannabis abuse, continuous Nondependent cannabis abuse, episodic Nondependent hallucinogen abuse, continuous Nondependent hallucinogen abuse, episodic Nondependent sedative hypnotic or anxiolytic abuse, continuous Nondependent sedative, hypnotic or anxiolytic abuse, episodic Nondependent opioid abuse, continuous Nondependent opioid abuse, episodic Nondependent cocaine abuse, continuous Nondependent cocaine abuse, episodic Nondependent amphetamine or related acting sympathomimetic abuse, continuous Nondependent amphetamine or related acting sympathomimetic abuse, episodic Nondependent antidepressant type abuse, continuous Nondependent antidepressant type abuse, episodic Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 80500-80502 Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 80102........................ 0.00 0.00 0.00 0.00 0.00 0.00 88 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 80103 80103 Tissue preparation for drug analysis Explanation Tissue is sometimes tested for the presence of drugs. This code reports the tissue preparation only. Coding Tips If a specimen is transported to an outside laboratory, report 99000 for handling or conveyance. CPT codes 80100–80103 are used to indicate the qualitative screening of drugs or classes of drugs. Those drugs commonly assayed include alcohols, amphetamines, barbiturates, benzodiazepines, cocaine and metabolites, methadones, methaqualones, opiates, phencylidines, propoxyphenes, phenothiazines, propoxyphenes, tetrahydrocannabinoids, and tricyclic antidepressants. Terms To Know tissue. Group of similar cells with a similar function that form definite structures and organs. Tissue types include epithelial tissue, muscle tissue, connective tissue, and nervous tissue. ICD-9-CM Diagnostic Codes V70.4 Examination for medicolegal reason — (Use additional code(s) to identify any special screening examination(s) performed: V73.0-V82.9) Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. Work Value 80103........................ 0.00 © 2014 OptumInsight, Inc. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.00 0.00 0.00 0.00 0.00 CPT © 2014 American Medical Association. All Rights Reserved. 89 Procedure Codes Coding and Payment Guide for Behavioral Health Services 80152 identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, mild — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, moderate — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, severe, without mention of psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, severe, specified as with psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, mild — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, moderate — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, severe, without mention of psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, severe, specified as with psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Poisoning by tricyclic antidepressants 80152 296.31 Amitriptyline Explanation Amitriptyline is a tricyclic antidepressant and the prototype brand name is Elavil. Test specimens are frequently collected at the trough period, which is about 12 hours after the last dose when serum concentration is at its lowest. This is an effective approach to determine a therapeutic level of drug. Drug overdose may be reason for the test as well. Method is typically high performance liquid chromatography (HPLC) or gas liquid chromatography (GLC). This drug may be prescribed for disorders outside of depressive states, such as chronic pain. 296.32 296.33 Coding Tips This examination is quantitative. For nonquantitative testing, see 80100–80103. To report the professional services for drug management, see HCPCS Level II code M0064, CPT code 90863, the appropriate level of E/M service, or the appropriate psychotherapy with E/M service code. Follow third-party payer guidelines when selecting the appropriate code for these services. If a specimen is transported to an outside laboratory, report 99000 for handling or conveyance. Episodic mood disorders (classified to category 296 in ICD-9-CM) are recurrent, severe disturbances of mood accompanied by one or more of the following: delusions, perplexity, disturbed attitude to self, or disorder of perception and behavior. While subcategories identify the type (e.g., manic or major depressive, bipolar, etc.) and episodic nature (e.g., single, recurrent, etc.) of the disorder, the fifth-digit assignment identifies severity of the episode. Amitriptyline may also be used in the treatment of pain. ICD-9-CM category 338 Pain, not elsewhere classified, provides subclassification codes that enable reporting of specific underlying causes of pain, as well as its acuity or chronicity. Category 338 contains an instructional note to coders to use an additional code (307.89) to identify pain associated with psychological factors. It also contains an exclusions note for generalized and localized pain, as well as pain disorder exclusively attributed to psychological factors. 296.34 296.51 296.52 296.53 296.54 ICD-9-CM Diagnostic Codes 296.21 296.22 296.23 296.24 Major depressive disorder, single episode, mild — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, single episode, moderate — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, single episode, severe, without mention of psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, single episode, severe, specified as with psychotic behavior — (Use additional code to Work Value 969.05 Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 80152........................ 0.00 0.00 0.00 0.00 0.00 0.00 90 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 80154 80154 293.0 293.1 Benzodiazepines 293.81 Explanation Benzodiazepines encompass a family of mild sedatives, including diazepam (Valium) and Ativan. These drugs may be assayed to determine therapeutic levels, or sometimes to determine levels in the system following overdose. Test specimens are frequently collected at the trough period, which is about 12 hours after the last dose when serum concentration is at its lowest. Method is high performance liquid chromatography (HPLC), gas liquid chromatography (GLC), or radioimmunoassay (RIA). This family of drugs may be prescribed for numerous conditions and disorders. Alcohol withdrawal is a common use for diazepam, as are muscle spasms. Coding Tips Each assay is separately reportable. This code reports quantitative therapeutic drug assay from any source. For qualitative testing, see CPT codes 81000-80103. Test assays are frequently collected at peak and trough periods (i.e., shortly after administration of the drug and approximately 12 hours after drug administration). If a specimen is transported to an outside laboratory, report code 99000 for handling or conveyance. 293.82 293.83 293.84 Delirium due to conditions classified elsewhere — (Code first the associated physical or neurological condition) Subacute delirium — (Code first the associated physical or neurological condition) Psychotic disorder with delusions in conditions classified elsewhere — (Code first the associated physical or neurological condition) Psychotic disorder with hallucinations in conditions classified elsewhere — (Code first the associated physical or neurological condition) Mood disorder in conditions classified elsewhere — (Code first the associated physical or neurological condition) Anxiety disorder in conditions classified elsewhere — (Code first the associated physical or neurological condition) Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. ICD-9-CM Diagnostic Codes 291.0 291.1 291.2 291.3 291.4 291.5 291.81 291.89 292.0 292.11 292.12 292.2 292.81 292.89 Alcohol withdrawal delirium Alcohol-induced persisting amnestic disorder Alcohol-induced persisting dementia Alcohol-induced psychotic disorder with hallucinations Idiosyncratic alcohol intoxication Alcohol-induced psychotic disorder with delusions Alcohol withdrawal Other specified alcohol-induced mental disorders Drug withdrawal — (Use additional code for any associated drug dependence: 304.0-304.9. Use additional E code to identify drug) Drug-induced psychotic disorder with delusions — (Use additional code for any associated drug dependence: 304.0-304.9. Use additional E code to identify drug) Drug-induced psychotic disorder with hallucinations — (Use additional code for any associated drug dependence: 304.0-304.9. Use additional E code to identify drug) Pathological drug intoxication — (Use additional code for any associated drug dependence: 304.0-304.9. Use additional E code to identify drug) Drug-induced delirium — (Use additional code for any associated drug dependence: 304.0-304.9. Use additional E code to identify drug) Other specified drug-induced mental disorder — (Use additional code for any associated drug dependence: 304.0-304.9. Use additional E code to identify drug) Work Value 80154........................ 0.00 © 2014 OptumInsight, Inc. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.00 0.00 0.00 0.00 0.00 CPT © 2014 American Medical Association. All Rights Reserved. 91 Procedure Codes Coding and Payment Guide for Behavioral Health Services 80155 80155 Caffeine Explanation Caffeine is the most widely consumed stimulant in the world and is found in beverages, foods, and medications. This drug may cause moderate to severe symptoms and/or caffeine toxicity. Blood specimen is collected via venipuncture. Test specimens are collected randomly rather than at trough level. A quantitative analysis of caffeine in the bloodstream does not influence medical management of the patient. This test is most commonly used on neonatal patients that are not responding to caffeine therapy or have suspected toxicity of caffeine. Method is enzyme immunoassay (EIA). Coding Tips This code is new for 2014. This test is quantitative. For nonquantitative testing, see 80100-80104. If specimen is transported to an outside laboratory, report 99000 for handling or conveyance. ICD-9-CM Diagnostic Codes 292.85 785.0 785.1 786.50 969.71 E854.2 E980.3 V72.60 Drug induced sleep disorders — (Use additional code for any associated drug dependence: 304.0-304.9. Use additional E code to identify drug) Unspecified tachycardia Palpitations Chest pain, unspecified Poisoning by caffeine Accidental poisoning by psychostimulants Poisoning by tranquilizers and other psychotropic agents, undetermined whether accidentally or purposely inflicted Laboratory examination, unspecified Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 80155........................ 0.00 0.00 0.00 0.00 0.00 0.00 92 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 80156 pain, as well as pain disorder exclusively attributed to psychological factors. 80156 ICD-9-CM Diagnostic Codes Carbamazepine; total 296.41 Explanation This drug, also known as Tegretol, is an enzyme inducer. Blood specimen collection is by venipuncture. CSF is obtained by spinal puncture, which is reported separately. Test specimens for total levels (80156) are frequently collected at the trough period, which is about 12 hours after the last dose when serum concentration is at its lowest. This is an effective approach to determine a therapeutic level of drug. Test specimens for free drug concentrations (80157) may be collected near peak levels about two to eight hours after ingestion. Methods include high performance liquid chromatography (HPLC) or gas liquid chromatography (GLC) for both types of analysis. This drug is absorbed slowly and erratically by the GI tract and a total concentration may be required, depending on the treatment underway. Methods include high performance liquid chromatography (HPLC) or gas liquid chromatography (GLC). Tegretol may be administered for such conditions as trigeminal neuralgia, epilepsy, and manic disorders. It is known for its anticonvulsant and pain management properties. 296.42 296.43 296.44 Coding Tips This examination is quantitative. See 80100-80103 for nonquantitative testing. To report the professional services for drug management, see HCPCS Level II code M0064, CPT code 90863, the appropriate level of E/M service, or the appropriate psychotherapy with E/M service code. Follow third-party payer guidelines when selecting the appropriate code for these services. If a specimen is transported to an outside laboratory, report 99000 for handling or conveyance. Episodic mood disorders (classified to category 296 in ICD-9-CM) are recurrent, severe disturbances of mood accompanied by one or more of the following: delusions, perplexity, disturbed attitude to self, or disorder of perception and behavior. When coding a bipolar disorder, correct code assignment is dependent upon the patient's mood. Assign a fourth digit of 0 or 4 when the documentation indicates that the patient is in the manic phase; characterized by hyperactivity, extreme agitation or exaggerated excitability, and/or accelerated speech and thought processes. A fourth digit of 5 should be assigned when the patient is in the depressive phase. Medical record documentation may indicate that the patient is exhibiting sadness, low self-esteem, feelings of guilt, interrupted sleep, or withdrawal from family and/or friends. A bipolar disorder may also be mixed and documentation indicates that the patient exhibits mood ranges from manic to depressive. A fourth digit of 6 is reported when this is documented. A fifth digit must also be assigned indicating the severity of the disorder when one of these fourth digits is assigned. A fourth digit of 7 or 8 indicates a bipolar I disorder of unspecified phase or an unspecified bipolar disorder, respectively. ICD-9-CM code 296.89 is used to report bipolar II disorders. This drug may also be used in the treatment of pain. ICD-9-CM category 338 Pain, not elsewhere classified, provides subclassification codes that enable reporting of specific underlying causes of pain, as well as its acuity or chronicity. Category 338 contains an instructional note to coders to use an additional code (307.89) to identify pain associated with psychological factors. It also contains an exclusions note for generalized and localized Work Value 80156........................ 0.00 © 2014 OptumInsight, Inc. 296.61 296.62 296.63 296.64 Bipolar I disorder, most recent episode (or current) manic, mild — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) manic, moderate — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) manic, severe, without mention of psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) manic, severe, specified as with psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) mixed, mild — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) mixed, moderate — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) mixed, severe, without mention of psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) mixed, severe, specified as with psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.00 0.00 0.00 0.00 0.00 CPT © 2014 American Medical Association. All Rights Reserved. 93 Procedure Codes Coding and Payment Guide for Behavioral Health Services 80159 associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Simple schizophrenia, chronic condition with acute exacerbation — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Simple schizophrenia, in remission — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Disorganized schizophrenia, subchronic condition — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Disorganized schizophrenia, chronic condition — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Disorganized schizophrenia, subchronic condition with acute exacerbation — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Disorganized schizophrenia, chronic condition with acute exacerbation — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Disorganized schizophrenia, in remission — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Poisoning by other antipsychotics, neuroleptics, and major tranquilizers — (Use additional code to specify the effects of poisoning) Accidental poisoning by other specified tranquilizers Other antipsychotics, neuroleptics, and major tranquilizers causing adverse effect in therapeutic use Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents Poisoning by tranquilizers and other psychotropic agents, undetermined whether accidentally or purposely inflicted Laboratory examination, unspecified 80159 295.04 Clozapine Explanation This drug, also known as Clozaril, is an atypical antipsychotic used to treat severe cases of schizophrenia in which the patient is a threat to themselves and/or others. It changes the activity of certain chemical processes in the brain. Agranulocytosis is the most common side effect and therefore white blood cell and absolute neutrophil count are required weekly for the first six months, biweekly for the second six months, and every four weeks after a year of being maintained on clozapine. Blood specimen is collected by venipuncture usually during the trough period. Methods include liquid chromatography and tandem mass spectrometry. 295.05 295.11 295.12 Coding Tips This code is new for 2014. This test is quantitative. To report nonquantitative testing, see 80100-80104. If specimen is transported to an outside laboratory, report 99000 for handling or conveyance. Schizophrenia is not diagnosed unless there is characteristic disturbance of at least two of these areas: thought, perception, mood, conduct, and personality. The first axis of coding schizophrenia is to identify the type (e.g., simple, disordered, paranoid, latent, residual, etc.). Identify the course of illness with a fifth digit, as follows: 0 Unspecified, 1 Subchronic state: continuous for more than six months but less than two years, 2 Chronic state: continuous for more than two years, 3 Subchronic with acute exacerbation: continuous for more than six months but less than two years but psychotic features have resurfaced in patient who has been in residual phase, 4 Chronic with acute exacerbation: continuous for more than two years but psychotic features have resurfaced in patient who has been in residual phase and, 5 In remission: history of schizophrenia but free from symptoms, regardless of whether patient is currently on medication. When the medical record documentation indicates that the patient suffered an overdose of the drug, either accidental or as a suicide attempt, see the Table of Drugs and Chemicals to locate the appropriate external cause (E) code. ICD-9-CM Diagnostic Codes 295.00 295.01 295.02 295.03 Simple schizophrenia, unspecified condition — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Simple schizophrenia, subchronic condition — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Simple schizophrenia, chronic condition — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Simple schizophrenia, subchronic condition with acute exacerbation — (Use additional code to identify any Work Value 295.13 295.14 295.15 969.3 E853.8 E939.3 E950.3 E980.3 V72.60 Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 80159........................ 0.00 0.00 0.00 0.00 0.00 0.00 94 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 80160 80160 296.32 Desipramine 296.33 Explanation This drug is also known as Norpramin and is among the tricyclic antidepressants. Steady state test specimens are frequently collected at the trough period, which is about 12 hours after the last dose when serum concentration is at its lowest. This is an effective approach to determine a therapeutic level of drug. Overdose is also a reason to run this test. Method is high performance liquid chromatography (HPLC) or gas liquid chromatography (GLC). 296.34 Coding Tips For nonquantitative testing, see 80100–80103. To report the professional services for drug management, see HCPCS Level II code M0064, CPT code 90863, the appropriate level of E/M service, or the appropriate psychotherapy with E/M service code. Follow third-party payer guidelines when selecting the appropriate code for these services. Episodic mood disorders (classified to category 296 in ICD-9-CM) are recurrent, severe disturbances of mood accompanied by one or more of the following: delusions, perplexity, disturbed attitude to self, or disorder of perception and behavior. While subcategories identify the type (e.g., manic or major depressive, bipolar, etc.) and episodic nature (e.g., single, recurrent, etc.) of the disorder, the fifth-digit assignment identifies severity of the episode. 296.36 296.52 296.53 ICD-9-CM Diagnostic Codes 296.21 296.22 296.23 296.24 296.26 296.31 Major depressive disorder, single episode, mild — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, single episode, moderate — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, single episode, severe, without mention of psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, single episode, severe, specified as with psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, single episode in full remission — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, mild — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Work Value 80160........................ 0.00 © 2014 OptumInsight, Inc. 296.54 296.56 300.3 300.4 Major depressive disorder, recurrent episode, moderate — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, severe, without mention of psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, severe, specified as with psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, in full remission — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, moderate — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, severe, without mention of psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, severe, specified as with psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, in full remission — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Obsessive-compulsive disorders Dysthymic disorder Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.00 0.00 0.00 0.00 0.00 CPT © 2014 American Medical Association. All Rights Reserved. 95 Procedure Codes Coding and Payment Guide for Behavioral Health Services 80164 80164 296.01 Dipropylacetic acid (valproic acid) Explanation 296.02 This drug is also known as Depakene. This drug is often used to treat seizures. Test specimens are frequently collected at the trough period, which is about 12 hours after the last dose when serum concentration is at its lowest. This is an effective approach to determine a therapeutic level of drug. Method is gas liquid chromatography (GLC), gas chromatography-mass spectrometry (GC-MS), and enzyme immunoassay (EIA). 296.03 296.04 Coding Tips This examination is quantitative. For nonquantitative testing, see 80100–80103. To report the professional services for drug management, see HCPCS Level II code M0064, CPT code 90863, the appropriate level of E/M service, or the appropriate psychotherapy with E/M service code. Follow third-party payer guidelines when selecting the appropriate code for these services. If a specimen is transported to an outside laboratory, report 99000 for handling or conveyance. Epilepsy is a disorder characterized by recurrent transient disturbances of the cerebral function. An abnormal paroxysmal neuronal discharge in the brain usually results in convulsive seizures, but may result in loss of consciousness, abnormal behavior, and sensory disturbances in any combination. Epilepsy may be secondary to prior trauma, hemorrhage, intoxication (toxins), chemical imbalances, anoxia, infections, neoplasms, or congenital defects. The ICD-9-CM alphabetic index provides guidance regarding appropriate code assignment for single, recurrent or repetitive seizures and seizure disorder. Accordingly, a single seizure is reported with code 780.39. Recurrent or repetitive seizures are reported with code 345.9x Epilepsy, unspecified. Report code 345.9x Epilepsy, unspecified, for seizure disorder, not otherwise specified, and recurrent seizures. While subcategories identify the specific type of seizure, fifth-digit assignment identifies if intractable epilepsy is present: 0 Without mention of intractable epilepsy, 1 With intractable epilepsy. Terms To Know bipolar disorder. Manic-depressive psychosis that has appeared in both the depressive and manic form, either alternating or separated by an interval of normality. Atypical: Episode of affective psychosis with some, but not all, of the features of the one form of the disorder in individuals who have had a previous episode of the other form of the disorder. intractable. Resistant to relief. status epilepticus. More than 30 minutes of continuous seizure or multiple sequential seizures without a return to consciousness in between. Treatment usually begins after five minutes of seizure activity. ICD-9-CM Diagnostic Codes 296.00 296.40 296.41 296.42 296.43 296.44 Bipolar I disorder, single manic episode, mild — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, single manic episode, moderate — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, single manic episode, severe, without mention of psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, single manic episode, severe, specified as with psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) manic, unspecified — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) manic, mild — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) manic, moderate — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) manic, severe, without mention of psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) manic, severe, specified as with psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. Bipolar I disorder, single manic episode, unspecified — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 80164........................ 0.00 0.00 0.00 0.00 0.00 0.00 96 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 80166 80166 296.32 Doxepin Explanation 296.33 This drug is also known as Sinequan or Adapin. This drug is classified as a tricyclic antidepressant (TCA). Steady state test specimens are frequently collected at the trough period, which is about 12 hours after the last dose when serum concentration is at its lowest. This is an effective approach to determine a therapeutic level of drug. Overdose may also prompt this test. Method is high performance liquid chromatography (HPLC), gas liquid chromatography (GLC), gas chromatography-mass spectrometry (GC-MS), and radioimmunoassay (RIA). 296.34 296.36 Coding Tips This examination is quantitative. For nonquantitative testing, see 80100–80103. To report the professional services for drug management, see HCPCS Level II code M0064, CPT code 90863, the appropriate level of E/M service, or the appropriate psychotherapy with E/M service code. Follow third-party payer guidelines when selecting the appropriate code for these services. If a specimen is transported to an outside laboratory, report 99000 for handling or conveyance. Episodic mood disorders (classified to category 296 in ICD-9-CM) are recurrent, severe disturbances of mood accompanied by one or more of the following: delusions, perplexity, disturbed attitude to self, or disorder of perception and behavior. While subcategories identify the type (e.g., manic or major depressive, bipolar, etc.) and episodic nature (e.g., single, recurrent, etc.) of the disorder, the fifth-digit assignment identifies severity of the episode. 296.51 296.52 296.53 ICD-9-CM Diagnostic Codes 296.22 296.23 296.24 296.26 296.31 Major depressive disorder, single episode, moderate — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, single episode, severe, without mention of psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, single episode, severe, specified as with psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, single episode in full remission — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, mild — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Work Value 80166........................ 0.00 © 2014 OptumInsight, Inc. 296.54 296.56 Major depressive disorder, recurrent episode, moderate — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, severe, without mention of psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, severe, specified as with psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, in full remission — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, mild — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, moderate — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, severe, without mention of psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, severe, specified as with psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, in full remission — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.00 0.00 0.00 0.00 0.00 CPT © 2014 American Medical Association. All Rights Reserved. 97 Procedure Codes Coding and Payment Guide for Behavioral Health Services 80173 80173 295.31 Haloperidol Explanation 295.32 This drug, also known as Haldol, is a well-established tranquilizer with antipsychotic and other properties. Blood concentrations of haloperidol do not correspond well with therapeutic dosages; therefore, assays may be performed to establish compliance or to measure the body's ability to metabolize the drug. Methods may include high performance liquid chromatography (HPLC), gas liquid chromatography (GLC), and radioimmunoassay (RIA). 295.41 295.42 Coding Tips This examination is quantitative. See 80100–80103 for nonquantitative testing. If a specimen is transported to an outside laboratory, report 99000 for handling or conveyance. To report the professional services for drug management, see HCPCS Level II code M0064, CPT code 90863, the appropriate level of E/M service, or the appropriate psychotherapy with E/M service code. Follow third-party payer guidelines when selecting the appropriate code for these services. Schizophrenia is not diagnosed unless there is characteristic disturbance of at least two of these areas: thought, perception, mood, conduct, and personality. The first axis of coding schizophrenia is to identify the type (e.g., simple, disordered, paranoid, latent, residual, etc.). Identify the course of illness with a fifth-digit, as follows: 0 Unspecified, 1 Subchronic state: continuous for more than six months but less than two years, 2 Chronic state: continuous for more than two years, 3 Subchronic with acute exacerbation: continuous for more than six months but less than two years but psychotic features have resurfaced in patient who has been in residual phase, 4 Chronic with acute exacerbation: continuous for more than two years but psychotic features have resurfaced in patient who has been in residual phase, and 5 In remission: history of schizophrenia but free from symptoms, regardless of whether patient is currently on medication. 295.51 295.52 295.61 295.62 295.71 ICD-9-CM Diagnostic Codes 295.01 295.02 295.11 295.12 Simple schizophrenia, subchronic condition — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Simple schizophrenia, chronic condition — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Disorganized schizophrenia, subchronic condition — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Disorganized schizophrenia, chronic condition — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Work Value 295.72 Paranoid schizophrenia, subchronic condition — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Paranoid schizophrenia, chronic condition — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Schizophreniform disorder, subchronic — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Schizophreniform disorder, chronic — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Latent schizophrenia, subchronic condition — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Latent schizophrenia, chronic condition — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Schizophrenic disorders, residual type, subchronic — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Schizophrenic disorders, residual type, chronic — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Schizoaffective disorder, subchronic — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Schizoaffective disorder, chronic — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 80173........................ 0.00 0.00 0.00 0.00 0.00 0.00 98 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 80174 80174 296.33 Imipramine Explanation This drug may also be known as Tofranil. The drug is classified as a tricyclic antidepressant (TCA). Steady state test specimens are frequently collected at the trough period, which is about 12 hours after the last dose when serum concentration is at its lowest. This is an effective approach to determine a therapeutic level of drug. Overdose may also prompt this test. Method is high performance liquid chromatography (HPLC), gas liquid chromatography (GLC), gas chromatography-mass spectrometry (GC-MS), and radioimmunoassay (RIA). Coding Tips This examination is quantitative. For nonquantitative testing, see 80100–80103. To report the professional services for drug management, see HCPCS Level II code M0064, CPT code 90863, the appropriate level of E/M service, or the appropriate psychotherapy with E/M service code. Follow third-party payer guidelines when selecting the appropriate code for these services. Episodic mood disorders (classified to category 296 in ICD-9-CM) are recurrent, severe disturbances of mood accompanied by one or more of the following: delusions, perplexity, disturbed attitude to self, disorder of perception and behavior. While subcategories identify the type (e.g., manic or major depressive, bipolar, etc.) and episodic nature (e.g., single, recurrent, etc.) of the disorder, the fifth-digit assignment identifies severity of the episode. 296.34 296.51 296.52 296.53 296.54 ICD-9-CM Diagnostic Codes 296.21 296.22 296.23 296.24 296.26 296.32 Major depressive disorder, single episode, mild — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, single episode, moderate — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, single episode, severe, without mention of psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, single episode, severe, specified as with psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, single episode in full remission — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, moderate — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Work Value 80174........................ 0.00 © 2014 OptumInsight, Inc. 296.56 296.82 300.4 969.05 Major depressive disorder, recurrent episode, severe, without mention of psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, severe, specified as with psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, mild — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, moderate — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, severe, without mention of psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, severe, specified as with psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, in full remission — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Atypical depressive disorder — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Dysthymic disorder Poisoning by tricyclic antidepressants Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.00 0.00 0.00 0.00 0.00 CPT © 2014 American Medical Association. All Rights Reserved. 99 Procedure Codes Coding and Payment Guide for Behavioral Health Services 80178 80178 296.34 Lithium Explanation This drug may also be known as Eskalith. Lithium is a naturally occurring mineral and its salts may be used in the treatment of mental disorders, in particular bipolar depression. Steady state test specimens are frequently collected at the trough period, which is about 12 hours after the last dose when serum concentration is at its lowest. This is an effective approach to determine a therapeutic level of drug. Methods may include flame emission spectroscopy (FES), atomic absorption spectrophotometry (AAS), and ion-specific electrode (ISE). This examination is quantitative. See 80100–80103 for nonquantitative testing. To report the professional services for drug management, see HCPCS Level II code M0064, CPT code 90863, the appropriate level of E/M service, or the appropriate psychotherapy with E/M service code. Follow third-party payer guidelines when selecting the appropriate code for these services. If a specimen is transported to an outside laboratory, report 99000 for handling or conveyance. 296.24 296.25 296.26 296.31 296.32 Major depressive disorder, single episode, mild — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, single episode, moderate — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, single episode, severe, specified as with psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, single episode, in partial or unspecified remission — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, single episode in full remission — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, mild — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, moderate — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Work Value 296.52 296.54 ICD-9-CM Diagnostic Codes 296.22 296.36 296.51 Coding Tips 296.21 296.35 296.55 296.56 296.82 Major depressive disorder, recurrent episode, severe, specified as with psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, in partial or unspecified remission — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, in full remission — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, mild — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, moderate — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, severe, specified as with psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, in partial or unspecified remission — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, in full remission — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Atypical depressive disorder — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 80178........................ 0.00 0.00 0.00 0.00 0.00 0.00 100 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 80182 80182 296.25 Nortriptyline Explanation This drug may also be known as Aventyl or Pamelor. This drug is classified as a tricyclic antidepressant (TCA). Steady state test specimens are frequently collected at the trough period, which is about 12 hours after the last dose when serum concentration is at its lowest. This is an effective approach to determine a therapeutic level of drug. Overdose may also prompt this test. Any of a number of methods may be used, including high performance liquid chromatography (HPLC), gas liquid chromatography (GLC), and gas chromatography-mass spectrometry (GC-MS). This examination is quantitative. See 80100–80103 for nonquantitative testing. To report the professional services for drug management, see HCPCS Level II code M0064, CPT code 90863, the appropriate level of E/M service, or the appropriate psychotherapy with E/M service code. Follow third-party payer guidelines when selecting the appropriate code for these services. If a specimen is transported to an outside laboratory, report 99000 for handling or conveyance. Episodic mood disorders (classified to category 296 in ICD-9-CM) are recurrent, severe disturbances of mood accompanied by one or more of the following: delusions, perplexity, disturbed attitude to self, or disorder of perception and behavior. While subcategories identify the type (e.g., manic or major depressive, bipolar, etc.) and episodic nature (e.g., single, recurrent, etc.) of the disorder, the fifth-digit assignment identifies severity of the episode: 0 Unspecified, 1 Mild, 2 Moderate, 3 Severe, without mention of psychotic behavior, 4 Severe, specified as with psychotic behavior, 5 In partial or unspecified remission, and 6 In full remission. 296.22 296.23 296.24 Major depressive disorder, single episode, unspecified — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, single episode, mild — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, single episode, moderate — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, single episode, severe, without mention of psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, single episode, severe, specified as with psychotic behavior — (Use additional code to Work Value 80182........................ 0.00 © 2014 OptumInsight, Inc. 296.33 296.50 296.51 296.52 ICD-9-CM Diagnostic Codes 296.21 296.31 296.32 Coding Tips 296.20 296.30 296.82 969.05 identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, single episode, in partial or unspecified remission — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, unspecified — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, mild — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, moderate — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, severe, without mention of psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, unspecified — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, mild — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, moderate — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Atypical depressive disorder — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Poisoning by tricyclic antidepressants Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.00 0.00 0.00 0.00 0.00 CPT © 2014 American Medical Association. All Rights Reserved. 101 Procedure Codes Coding and Payment Guide for Behavioral Health Services 80183 any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, single manic episode, in full remission — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Manic disorder, recurrent episode, unspecified — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Manic disorder, recurrent episode, mild — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Manic disorder, recurrent episode, moderate — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Manic disorder, recurrent episode, severe, without mention of psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Manic disorder, recurrent episode, severe, specified as with psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Laboratory examination, unspecified 80183 296.06 Oxcarbazepine Explanation Oxcarbazepine is also known as Trileptal and is an anticonvulsant and mood stabilizer used to treat epilepsy, motor tics, bipolar disorder, and anxiety. Test specimen is blood collected via venipuncture. This is an effective approach to determine a therapeutic level. Methods include tandem mass spectrometry or liquid chromatography. 296.11 Coding Tips This code is new for 2014. It is for quantitative testing. For nonquantiative testing see 80100-80104. If specimen is transported to an outside laboratory, report 99000 for handling or conveyance. Schizophrenia is not diagnosed unless there is characteristic disturbance of at least two of these areas: thought, perception, mood, conduct, and personality. The first axis of coding schizophrenia is to identify the type (e.g., simple, disordered, paranoid, latent, residual, etc.). Identify the course of illness with a fifth digit, as follows: 0 Unspecified, 1 Subchronic state: continuous for more than six months but less than two years, 2 Chronic state: continuous for more than two years, 3 Subchronic with acute exacerbation: continuous for more than six months but less than two years but psychotic features have resurfaced in patient who has been in residual phase, 4 Chronic with acute exacerbation: continuous for more than two years but psychotic features have resurfaced in patient who has been in residual phase and, 5 In remission: history of schizophrenia but free from symptoms, regardless of whether patient is currently on medication. When the medical record documentation indicates that the patient suffered an overdose of the drug, either accidental or as a suicide attempt, see the Table of Drugs and Chemicals to locate the appropriate external cause (E) code.</ ICD-9-CM Diagnostic Codes 296.01 296.02 296.03 296.04 296.05 296.10 Bipolar I disorder, single manic episode, mild — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, single manic episode, moderate — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, single manic episode, severe, without mention of psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, single manic episode, severe, specified as with psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, single manic episode, in partial or unspecified remission — (Use additional code to identify Work Value 296.12 296.13 296.14 V72.60 Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 80183........................ 0.00 0.00 0.00 0.00 0.00 0.00 102 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 80184 80184 345.41 Phenobarbital 345.50 Explanation This drug may also be known as Luminal. This drug may be administered to control seizures. Test specimens are frequently collected at the trough period, which is about 12 hours after the last dose when serum concentration is at its lowest. This is an effective approach to determine a therapeutic level of drug. Methodology may include gas liquid chromatography (GLC) and high performance liquid chromatography (HPLC). Coding Tips This examination is quantitative. See 80100–80103 for nonquantitative testing. To report the professional services for drug management, see HCPCS Level II code M0064, CPT code 90863, the appropriate level of E/M service, or the appropriate psychotherapy with E/M service code. Follow third-party payer guidelines when selecting the appropriate code for these services. If a specimen is transported to an outside laboratory, report 99000 for handling or conveyance. The ICD-9-CM alphabetic index provides guidance regarding appropriate code assignment for single, recurrent or repetitive seizures and seizure disorder. Accordingly, a single seizure is reported with code 780.39. Recurrent or repetitive seizures are reported with code 345.9x Epilepsy, unspecified. Report code 345.9x Epilepsy, unspecified, for seizure disorder, not otherwise specified, and recurrent seizures. While subcategories identify the specific type of seizure, fifth-digit assignment identifies if intractable epilepsy is present: 0 Without mention of intractable epilepsy, 1 With intractable epilepsy. 345.51 345.70 345.71 345.80 345.81 345.90 345.91 780.33 780.39 Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, with intractable epilepsy Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, with intractable epilepsy Epilepsia partialis continua without mention of intractable epilepsy Epilepsia partialis continua with intractable epilepsy Other forms of epilepsy and recurrent seizures, without mention of intractable epilepsy Other forms of epilepsy and recurrent seizures, with intractable epilepsy Unspecified epilepsy without mention of intractable epilepsy Unspecified epilepsy with intractable epilepsy Post traumatic seizures Other convulsions Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. Terms To Know specimen. Tissue cells or sample of fluid taken for analysis, pathologic examination, and diagnosis. therapeutic. Act meant to alleviate a medical or mental condition. venipuncture. Piercing a vein through the skin by a needle and syringe or sharp-ended cannula or catheter to draw blood, start an intravenous infusion, instill medication, or inject another substance such as radiopaque dye. ICD-9-CM Diagnostic Codes 345.00 345.01 345.10 345.11 345.2 345.3 345.40 Generalized nonconvulsive epilepsy without mention of intractable epilepsy Generalized nonconvulsive epilepsy with intractable epilepsy Generalized convulsive epilepsy without mention of intractable epilepsy Generalized convulsive epilepsy with intractable epilepsy Epileptic petit mal status Epileptic grand mal status Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, without mention of intractable epilepsy Work Value 80184........................ 0.00 © 2014 OptumInsight, Inc. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.00 0.00 0.00 0.00 0.00 CPT © 2014 American Medical Association. All Rights Reserved. 103 Procedure Codes Coding and Payment Guide for Behavioral Health Services 80185-80186 80185 80186 345.40 Phenytoin; total 345.41 free Explanation This drug may also be known as Dilantin. This drug may be administered to control seizures. Steady state test specimens are frequently collected at the trough period, which is about 12 hours after the last dose when serum concentration is at its lowest. This is an effective approach to determine a therapeutic level of drug. Report 80185 for total serum levels and 80186 when free phenytoin is assayed. Methodology may include high performance liquid chromatography (HPLC), gas liquid chromatography (GLC), radioimmunoassay (RIA), and fluorescence polarization immunoassay (FPIA). Free phenytoin is assayed by ultracentrifugation. Phenytoin is a known teratogen (cause of birth defects) and lowest therapeutic levels possible are often sought. Coding Tips 345.50 345.51 345.70 345.71 345.80 345.81 This examination is quantitative. See 80100–80103 for nonquantitative testing. To report the professional services for drug management, see HCPCS Level II code M0064, CPT code 90863, the appropriate level of E/M service, or the appropriate psychotherapy with E/M service code. Follow third-party payer guidelines when selecting the appropriate code for these services. If a specimen is transported to an outside laboratory, report 99000 for handling or conveyance. The ICD-9-CM alphabetic index provides guidance regarding appropriate code assignment for single, recurrent or repetitive seizures and seizure disorder. Accordingly, a single seizure is reported with code 780.39. Recurrent or repetitive seizures are reported with code 345.9x Epilepsy, unspecified. Report code 345.9x Epilepsy, unspecified, for seizure disorder, not otherwise specified, and recurrent seizures. While subcategories identify the specific type of seizure, fifth-digit assignment identifies if intractable epilepsy is present: 0 Without mention of intractable epilepsy, 1 With intractable epilepsy. 345.90 345.91 780.39 Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, without mention of intractable epilepsy Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, with intractable epilepsy Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, with intractable epilepsy Epilepsia partialis continua without mention of intractable epilepsy Epilepsia partialis continua with intractable epilepsy Other forms of epilepsy and recurrent seizures, without mention of intractable epilepsy Other forms of epilepsy and recurrent seizures, with intractable epilepsy Unspecified epilepsy without mention of intractable epilepsy Unspecified epilepsy with intractable epilepsy Other convulsions Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. Terms To Know assay. Test of purity. teratogen. Substance, including radiation and chemicals, that causes aberrant development in an embryo or fetus. ICD-9-CM Diagnostic Codes 345.00 345.01 345.10 345.11 345.2 345.3 Generalized nonconvulsive epilepsy without mention of intractable epilepsy Generalized nonconvulsive epilepsy with intractable epilepsy Generalized convulsive epilepsy without mention of intractable epilepsy Generalized convulsive epilepsy with intractable epilepsy Epileptic petit mal status Epileptic grand mal status Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 80185........................ 0.00 80186........................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 104 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 80188 80188 345.41 Primidone 345.50 Explanation This drug may also be known as Mysoline. This drug may be administered to control seizures. Test specimens are frequently collected at the trough period, which is about 12 hours after the last dose when serum concentration is at its lowest. This is an effective approach to determine a therapeutic level of drug. Methodology may include high performance liquid chromatography (HPLC), gas liquid chromatography (GLC), or enzyme immunoassay (EIA). Coding Tips This examination is quantitative. See 80100–80103 for nonquantitative testing. To report the professional services for drug management, see HCPCS Level II code M0064, CPT code 90863, the appropriate level of E/M service, or the appropriate psychotherapy with E/M service code. Follow third-party payer guidelines when selecting the appropriate code for these services. If a specimen is transported to an outside laboratory, report 99000 for handling or conveyance. The ICD-9-CM alphabetic index provides guidance regarding appropriate code assignment for single, recurrent or repetitive seizures and seizure disorder. Accordingly, a single seizure is reported with code 780.39. Recurrent or repetitive seizures are reported with code 345.9x Epilepsy, unspecified. Report code 345.9x Epilepsy, unspecified, for seizure disorder, not otherwise specified, and recurrent seizures. While subcategories identify the specific type of seizure, fifth-digit assignment identifies if intractable epilepsy is present: 0 Without mention of intractable epilepsy, 1 With intractable epilepsy. 345.51 345.70 345.71 345.80 345.81 345.90 345.91 780.33 780.39 Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, with intractable epilepsy Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, with intractable epilepsy Epilepsia partialis continua without mention of intractable epilepsy Epilepsia partialis continua with intractable epilepsy Other forms of epilepsy and recurrent seizures, without mention of intractable epilepsy Other forms of epilepsy and recurrent seizures, with intractable epilepsy Unspecified epilepsy without mention of intractable epilepsy Unspecified epilepsy with intractable epilepsy Post traumatic seizures Other convulsions Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. Terms To Know specimen. Tissue cells or sample of fluid taken for analysis, pathologic examination, and diagnosis. therapeutic. Act meant to alleviate a medical or mental condition. venipuncture. Piercing a vein through the skin by a needle and syringe or sharp-ended cannula or catheter to draw blood, start an intravenous infusion, instill medication, or inject another substance such as radiopaque dye. ICD-9-CM Diagnostic Codes 345.00 345.01 345.10 345.11 345.2 345.3 345.40 Generalized nonconvulsive epilepsy without mention of intractable epilepsy Generalized nonconvulsive epilepsy with intractable epilepsy Generalized convulsive epilepsy without mention of intractable epilepsy Generalized convulsive epilepsy with intractable epilepsy Epileptic petit mal status Epileptic grand mal status Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, without mention of intractable epilepsy Work Value 80188........................ 0.00 © 2014 OptumInsight, Inc. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.00 0.00 0.00 0.00 0.00 CPT © 2014 American Medical Association. All Rights Reserved. 105 Procedure Codes Coding and Payment Guide for Behavioral Health Services 80196 80196 Salicylate Explanation This drug is known universally as aspirin and may also be referred to as a nonsteroidal antiinflammatory drug (NSAID). Specimen collection is at trough, which is the time just before the next dose of the drug when blood concentration is at its lowest. Overdose may also prompt this test. Methodology may include high performance liquid chromatography (HPLC) or gas liquid chromatography (GLC). Colorimetry and fluorometry may also be used. Coding Tips This examination is quantitative. See codes from range 80100–80103 for nonquantitative testing. If a specimen is transported to an outside laboratory, report code 99000 for handling or conveyance. When the medical record documentation indicates that the patient suffered an overdose of the drug, either accidental or as a suicide attempt, see the Table of Drugs and Chemicals to locate the appropriate external cause (E) code. Terms To Know assay. Test of purity. NSAID. Non-steroidal antiinflammatory drug. Analgesic and antiinflammatory drug commonly used to mitigate inflammatory conditions. NSAIDs include aspirin, ibuprofen, naproxen, and nabumetone. quantitative. To determine the amount and nature of the components of a substance. specimen. Tissue cells or sample of fluid taken for analysis, pathologic examination, and diagnosis. venipuncture. Piercing a vein through the skin by a needle and syringe or sharp-ended cannula or catheter to draw blood, start an intravenous infusion, instill medication, or inject another substance such as radiopaque dye. ICD-9-CM Diagnostic Codes The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. CCI Version 20.0 No CCI Edits apply to this code. Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 80196........................ 0.00 0.00 0.00 0.00 0.00 0.00 106 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 82055 82055 303.02 Alcohol (ethanol); any specimen except breath Explanation 303.03 This test may also be requested as ethanol, ethyl alcohol, or ETOH. If the specimen is blood (serum), collection is typically by venipuncture. Method is commonly enzymatic rate analysis (alcohol dehydrogenase). This test is typically performed to determine alcohol level for medical or legal purposes, to screen unconscious patients, to diagnose alcohol intoxication to determine appropriate therapy, and to monitor ethanol treatment for methanol intoxication. 303.90 303.91 Coding Tips Code 82055 is classified as a CLIA-waived test. Append with modifier QW. If a specimen is transported to an outside laboratory, report 99000 for handling or conveyance. For an alcohol breath test, see 82075. For alcohol volatiles, such as isopropyl alcohol, see 84600. Codes in categories 303 Alcohol dependence syndrome, and 305 Nondependent use of drugs, are reported using fifth-digit subclassifications that more specifically describe the episode of abuse. These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission. 303.92 303.93 Terms To Know ETOH. Alcohol. specimen. Tissue cells or sample of fluid taken for analysis, pathologic examination, and diagnosis. venipuncture. Piercing a vein through the skin by a needle and syringe or sharp-ended cannula or catheter to draw blood, start an intravenous infusion, instill medication, or inject another substance such as radiopaque dye. ICD-9-CM Diagnostic Codes 070.20 070.21 070.30 070.31 070.41 070.51 291.0 303.00 303.01 Viral hepatitis B with hepatic coma, acute or unspecified, without mention of hepatitis delta Viral hepatitis B with hepatic coma, acute or unspecified, with hepatitis delta Viral hepatitis B without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta Viral hepatitis B without mention of hepatic coma, acute or unspecified, with hepatitis delta Acute hepatitis C with hepatic coma Acute hepatitis C without mention of hepatic coma Alcohol withdrawal delirium Acute alcoholic intoxication, unspecified — (Use additional code to identify any associated condition: 291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2, 571.3) Acute alcoholic intoxication, continuous — (Use additional code to identify any associated condition: 291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2, 571.3) Work Value 82055........................ 0.00 © 2014 OptumInsight, Inc. 305.00 305.01 305.02 305.03 571.2 980.0 Acute alcoholic intoxication, episodic — (Use additional code to identify any associated condition: 291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2, 571.3) Acute alcoholic intoxication, in remission — (Use additional code to identify any associated condition: 291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2, 571.3) Other and unspecified alcohol dependence, unspecified — (Use additional code to identify any associated condition: 291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2, 571.3) Other and unspecified alcohol dependence, continuous — (Use additional code to identify any associated condition: 291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2, 571.3) Other and unspecified alcohol dependence, episodic — (Use additional code to identify any associated condition: 291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2, 571.3) Other and unspecified alcohol dependence, in remission — (Use additional code to identify any associated condition: 291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2, 571.3) Nondependent alcohol abuse, unspecified Nondependent alcohol abuse, continuous Nondependent alcohol abuse, episodic Nondependent alcohol abuse, in remission Alcoholic cirrhosis of liver Toxic effect of ethyl alcohol — (Use additional code to specify the nature of the toxic effect. Use additional code to identify any associated: 291.4, 303.0, 305.0) Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. IOM References 100-4,16,70.8 CCI Version 20.0 No CCI Edits apply to this code. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.00 0.00 0.00 0.00 0.00 CPT © 2014 American Medical Association. All Rights Reserved. 107 Procedure Codes Coding and Payment Guide for Behavioral Health Services 82075 82075 303.92 Alcohol (ethanol); breath 303.93 Explanation This test may be used primarily in screening for ethanol levels above the legal limit for driving. The legal limit varies from state to state with levels above 0.08-0.1 g/dL usually being defined as legally intoxicated. Coding Tips If a specimen is transported to an outside laboratory, report code 99000 for handling or conveyance. For an alcohol test, any specimen except breath, see code 82055. For alcohol volatiles, such as isopropyl alcohol, see 84600. Codes in categories 303 Alcohol dependence syndrome, and 305 Nondependent use of drugs, are reported using fifth-digit subclassifications that more specifically describe the episode of abuse. These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission. Terms To Know screening test. Exam or study used by a physician to identify abnormalities, regardless of whether the patient exhibits symptoms. 303.01 303.02 303.03 303.90 303.91 Alcohol-induced persisting dementia Alcohol-induced psychotic disorder with hallucinations Idiosyncratic alcohol intoxication Alcohol-induced psychotic disorder with delusions Acute alcoholic intoxication, unspecified — (Use additional code to identify any associated condition: 291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2, 571.3) Acute alcoholic intoxication, continuous — (Use additional code to identify any associated condition: 291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2, 571.3) Acute alcoholic intoxication, episodic — (Use additional code to identify any associated condition: 291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2, 571.3) Acute alcoholic intoxication, in remission — (Use additional code to identify any associated condition: 291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2, 571.3) Other and unspecified alcohol dependence, unspecified — (Use additional code to identify any associated condition: 291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2, 571.3) Other and unspecified alcohol dependence, continuous — (Use additional code to identify any associated condition: 291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2, 571.3) Work Value Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 ICD-9-CM Diagnostic Codes 291.2 291.3 291.4 291.5 303.00 305.00 305.01 305.02 305.03 980.0 Other and unspecified alcohol dependence, episodic — (Use additional code to identify any associated condition: 291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2, 571.3) Other and unspecified alcohol dependence, in remission — (Use additional code to identify any associated condition: 291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2, 571.3) Nondependent alcohol abuse, unspecified Nondependent alcohol abuse, continuous Nondependent alcohol abuse, episodic Nondependent alcohol abuse, in remission Toxic effect of ethyl alcohol — (Use additional code to specify the nature of the toxic effect. Use additional code to identify any associated: 291.4, 303.0, 305.0) No CCI Edits apply to this code. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 82075........................ 0.00 0.00 0.00 0.00 0.00 0.00 108 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 82145 82145 305.90 305.91 Amphetamine or methamphetamine 305.92 Explanation This test may be requested as a quantitative analysis of amphetamine/methamphetamine. A number of methods are used. Methods used for blood include gas-liquid chromatography (GLC), gas chromatometry/mass spectrometry (GC/MS), and radioimmunoassay (RIA). Methods used for urine include enzyme immunoassay (EIA), high performance liquid chromatography (HPLC), fluorescence polarization immunoassay (FPIA), and RIA. This test measures (quantifies) the amount of amphetamine or methamphetamine in the urine. Coding Tips Qualitative analysis should be identified using the appropriate code from range 80100–80103. Codes in categories 304 Drug dependence, and 305 Nondependent use of drugs, are reported using fifth-digit subclassifications that more specifically describe the episode of abuse. These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission. When the medical record documentation indicates that the patient suffered an overdose of the drug, either accidental or as a suicide attempt, see the Table of Drugs and Chemicals to locate the appropriate external cause (E) code. 305.93 780.1 780.97 Other, mixed, or unspecified nondependent drug abuse, unspecified Other, mixed, or unspecified nondependent drug abuse, continuous Other, mixed, or unspecified nondependent drug abuse, episodic Other, mixed, or unspecified nondependent drug abuse, in remission Hallucinations Altered mental status Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. Terms To Know assay. Test of purity. quantitative. To determine the amount and nature of the components of a substance. specimen. Tissue cells or sample of fluid taken for analysis, pathologic examination, and diagnosis. venipuncture. Piercing a vein through the skin by a needle and syringe or sharp-ended cannula or catheter to draw blood, start an intravenous infusion, instill medication, or inject another substance such as radiopaque dye. ICD-9-CM Diagnostic Codes 297.9 298.9 304.90 305.70 305.71 305.72 305.73 Unspecified paranoid state — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Unspecified psychosis — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Unspecified drug dependence, unspecified Nondependent amphetamine or related acting sympathomimetic abuse, unspecified Nondependent amphetamine or related acting sympathomimetic abuse, continuous Nondependent amphetamine or related acting sympathomimetic abuse, episodic Nondependent amphetamine or related acting sympathomimetic abuse, in remission Work Value 82145........................ 0.00 © 2014 OptumInsight, Inc. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.00 0.00 0.00 0.00 0.00 CPT © 2014 American Medical Association. All Rights Reserved. 109 Procedure Codes Coding and Payment Guide for Behavioral Health Services 82205 82205 305.93 780.97 967.0 Barbiturates, not elsewhere specified Explanation This test may be requested as a quantitative analysis of barbiturates. A number of methods are used. Methods used for blood include gas-liquid chromatography (GLC), gas chromatometry/mass spectrometry (GC/MS), and radioimmunoassay (RIA). Methods used for urine include enzyme immunoassay (EIA) and high performance liquid chromatography (HPLC). This test measures (quantifies) the amount of barbiturate. Coding Tips Qualitative analysis should be identified using the appropriate code from range 80100–80103. Codes in categories 304 Drug dependence, and 305 Nondependent use of drugs, are reported using fifth-digit subclassifications that more specifically describe the episode of abuse. These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission. When the medical record documentation indicates that the patient suffered an overdose of the drug, either accidental or as a suicide attempt, see the Table of Drugs and Chemicals to locate the appropriate external cause (E) code. V70.4 V72.62 Other, mixed, or unspecified nondependent drug abuse, in remission Altered mental status Poisoning by barbiturates — (Use additional code to specify the effects of poisoning) Examination for medicolegal reason — (Use additional code(s) to identify any special screening examination(s) performed: V73.0-V82.9) Laboratory examination ordered as part of a routine general medical examination Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. Terms To Know analysis. Study of body fluid, tissue, section, or parts. assay. Test of purity. quantitative. To determine the amount and nature of the components of a substance. specimen. Tissue cells or sample of fluid taken for analysis, pathologic examination, and diagnosis. ICD-9-CM Diagnostic Codes 304.10 304.11 304.12 304.13 304.90 305.40 305.41 305.42 305.43 305.90 305.91 305.92 Sedative, hypnotic or anxiolytic dependence, unspecified Sedative, hypnotic or anxiolytic dependence, continuous Sedative, hypnotic or anxiolytic dependence, episodic Sedative, hypnotic or anxiolytic dependence, in remission Unspecified drug dependence, unspecified Nondependent sedative, hypnotic or anxiolytic abuse, unspecified Nondependent sedative hypnotic or anxiolytic abuse, continuous Nondependent sedative, hypnotic or anxiolytic abuse, episodic Nondependent sedative, hypnotic or anxiolytic abuse, in remission Other, mixed, or unspecified nondependent drug abuse, unspecified Other, mixed, or unspecified nondependent drug abuse, continuous Other, mixed, or unspecified nondependent drug abuse, episodic Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 82205........................ 0.00 0.00 0.00 0.00 0.00 0.00 110 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 82520 82520 305.63 305.90 Cocaine or metabolite 305.91 Explanation Cocaine is a refined derivative of the coca plant and is a frequently abused drug. Blood specimen is obtained by venipuncture. Multiple methods may be used including enzyme immunoassay (EIA), fluorescence polarization immunoassay (FPIA), radioimmunoassay (RIA), gas-liquid chromatography (GLC), high performance liquid chromatography (HPLC), and gas chromatography/mass spectrometry (GC-MS). The procedure measures (quantifies) the amount of cocaine or its metabolites in the sample. Coding Tips Qualitative analysis should be identified using the appropriate code from range 80100-80103. Codes in categories 304 Drug dependence, and 305 Nondependent use of drugs are reported using fifth-digit subclassifications that more specifically describe the episode of abuse. These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission. When the medical record documentation indicates that the patient suffered an overdose of the drug, either accidental or as a suicide attempt, see the Table of Drugs and Chemicals to locate the appropriate external cause (E) code. Terms To Know assay. Test of purity. specimen. Tissue cells or sample of fluid taken for analysis, pathologic examination, and diagnosis. venipuncture. Piercing a vein through the skin by a needle and syringe or sharp-ended cannula or catheter to draw blood, start an intravenous infusion, instill medication, or inject another substance such as radiopaque dye. 305.92 305.93 780.1 780.97 970.81 V70.4 V72.62 Nondependent cocaine abuse, in remission Other, mixed, or unspecified nondependent drug abuse, unspecified Other, mixed, or unspecified nondependent drug abuse, continuous Other, mixed, or unspecified nondependent drug abuse, episodic Other, mixed, or unspecified nondependent drug abuse, in remission Hallucinations Altered mental status Poisoning by cocaine Examination for medicolegal reason — (Use additional code(s) to identify any special screening examination(s) performed: V73.0-V82.9) Laboratory examination ordered as part of a routine general medical examination Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. ICD-9-CM Diagnostic Codes 292.89 297.9 298.9 300.09 304.20 304.21 304.22 304.23 304.90 305.60 305.61 305.62 Other specified drug-induced mental disorder — (Use additional code for any associated drug dependence: 304.0-304.9. Use additional E code to identify drug) Unspecified paranoid state — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Unspecified psychosis — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Other anxiety states Cocaine dependence, unspecified Cocaine dependence, continuous Cocaine dependence, episodic Cocaine dependence, in remission Unspecified drug dependence, unspecified Nondependent cocaine abuse, unspecified Nondependent cocaine abuse, continuous Nondependent cocaine abuse, episodic Work Value 82520........................ 0.00 © 2014 OptumInsight, Inc. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.00 0.00 0.00 0.00 0.00 CPT © 2014 American Medical Association. All Rights Reserved. 111 Procedure Codes Coding and Payment Guide for Behavioral Health Services 82646 82646 305.50 305.51 305.52 305.53 305.90 Dihydrocodeinone Explanation This test may be requested as hydrocodone quantitative analysis. Dihydrocodeinone is an opioid having sedative and analgesic effects. Methods include radioimmunoassay (RIA), gas-liquid chromatography (GLC), enzyme immunoassay (EIA), high-performance liquid chromatography (HPLC) for blood, and fluorescence polarization immunoassay (FPIA) for urine. This test measures (quantifies) the amount of dihydrocodeinone present. Coding Tips 305.91 305.92 305.93 338.0 Qualitative analysis should be identified using the appropriate code from range 80100–80103. Codes in categories 304 Drug dependence, and 305 Nondependent use of drugs, are reported using fifth-digit subclassifications that more specifically describe the episode of abuse. These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission. This drug may also be used in the treatment of pain. ICD-9-CM category 338 Pain, not elsewhere classified, provides subclassification codes that enable reporting of specific underlying causes of pain, as well as its acuity or chronicity. Category 338 contains an instructional note to coders to use an additional code (307.89) to identify pain associated with psychological factors. It also contains an exclusions note for generalized and localized pain, as well as pain disorder exclusively attributed to psychological factors. When the medical record documentation indicates that the patient suffered an overdose of the drug, either accidental or as a suicide attempt, see the Table of Drugs and Chemicals to locate the appropriate external cause (E) code. Terms To Know 338.19 338.29 338.4 965.09 Nondependent opioid abuse, unspecified Nondependent opioid abuse, continuous Nondependent opioid abuse, episodic Nondependent opioid abuse, in remission Other, mixed, or unspecified nondependent drug abuse, unspecified Other, mixed, or unspecified nondependent drug abuse, continuous Other, mixed, or unspecified nondependent drug abuse, episodic Other, mixed, or unspecified nondependent drug abuse, in remission Central pain syndrome — (Use additional code to identify pain associated with psychological factors: 307.89) Other acute pain — (Use additional code to identify pain associated with psychological factors: 307.89) Other chronic pain — (Use additional code to identify pain associated with psychological factors: 307.89) Chronic pain syndrome — (Use additional code to identify pain associated with psychological factors: 307.89) Poisoning by opiates and related narcotics, other — (Use additional code to specify the effects of poisoning) Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. analgesia. Absence of a normal sense of pain without loss of consciousness. assay. Test of purity. quantitative. To determine the amount and nature of the components of a substance. ICD-9-CM Diagnostic Codes 292.89 297.9 298.9 304.00 304.01 304.02 304.03 304.90 Other specified drug-induced mental disorder — (Use additional code for any associated drug dependence: 304.0-304.9. Use additional E code to identify drug) Unspecified paranoid state — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Unspecified psychosis — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Opioid type dependence, unspecified Opioid type dependence, continuous Opioid type dependence, episodic Opioid type dependence, in remission Unspecified drug dependence, unspecified Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 82646........................ 0.00 0.00 0.00 0.00 0.00 0.00 112 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 82649 82649 305.90 305.91 Dihydromorphinone 305.92 Explanation This test may be requested as hydromorphone or Dilaudid quantitative analysis. Dihydromorphinone is an opioid. Methods include radioimmunoassay (RIA), gas-liquid chromatography (GLC), and enzyme immunoassay (EIA). Coding Tips 305.93 338.0 338.19 Qualitative analysis should be identified using the appropriate code from range 80100-80103. Codes in categories 304 Drug dependence, and 305 Nondependent use of drugs, are reported using fifth-digit subclassifications that more specifically describe the episode of abuse. These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission. This drug may also be used in the treatment of pain. ICD-9-CM category 338 Pain, not elsewhere classified, provides subclassification codes that enable reporting of specific underlying causes of pain, as well as its acuity or chronicity. Category 338 contains an instructional note to coders to use an additional code (307.89) to identify pain associated with psychological factors. It also contains an exclusions note for generalized and localized pain, as well as pain disorder exclusively attributed to psychological factors. When the medical record documentation indicates that the patient suffered an overdose of the drug, either accidental or as a suicide attempt, see the Table of Drugs and Chemicals to locate the appropriate external cause (E) code. 338.29 338.4 965.09 Other, mixed, or unspecified nondependent drug abuse, unspecified Other, mixed, or unspecified nondependent drug abuse, continuous Other, mixed, or unspecified nondependent drug abuse, episodic Other, mixed, or unspecified nondependent drug abuse, in remission Central pain syndrome — (Use additional code to identify pain associated with psychological factors: 307.89) Other acute pain — (Use additional code to identify pain associated with psychological factors: 307.89) Other chronic pain — (Use additional code to identify pain associated with psychological factors: 307.89) Chronic pain syndrome — (Use additional code to identify pain associated with psychological factors: 307.89) Poisoning by opiates and related narcotics, other — (Use additional code to specify the effects of poisoning) Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. Terms To Know qualitative. To determine the nature of the component of substance. quantitative. To determine the amount and nature of the components of a substance. ICD-9-CM Diagnostic Codes 292.89 297.9 298.9 304.00 304.01 304.02 304.03 304.90 305.50 305.51 305.52 305.53 Other specified drug-induced mental disorder — (Use additional code for any associated drug dependence: 304.0-304.9. Use additional E code to identify drug) Unspecified paranoid state — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Unspecified psychosis — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Opioid type dependence, unspecified Opioid type dependence, continuous Opioid type dependence, episodic Opioid type dependence, in remission Unspecified drug dependence, unspecified Nondependent opioid abuse, unspecified Nondependent opioid abuse, continuous Nondependent opioid abuse, episodic Nondependent opioid abuse, in remission Work Value 82649........................ 0.00 © 2014 OptumInsight, Inc. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.00 0.00 0.00 0.00 0.00 CPT © 2014 American Medical Association. All Rights Reserved. 113 Procedure Codes Coding and Payment Guide for Behavioral Health Services 82654 82654 305.50 305.51 305.52 305.53 305.90 Dimethadione Explanation This test may be requested as Methadone or Dolophine quantitative analysis. Dimethadione is an opioid. Methods include radioimmunoassay (RIA), gas-liquid chromatography (GLC), enzyme immunoassay (EIA), and high-performance liquid chromatography (HPLC). Coding Tips Qualitative analysis should be identified using the appropriate code from range 80100-80103. Codes in categories 304 Drug dependence and 305 Nondependent use of drugs are reported using fifth-digit subclassifications that more specifically describe the episode of abuse. These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission. This drug may also be used in the treatment of pain. ICD-9-CM category 338 Pain, not elsewhere classified, provides subclassification codes that enable reporting of specific underlying causes of pain, as well as its acuity or chronicity. Category 338 contains an instructional note to coders to use an additional code (307.89) to identify pain associated with psychological factors. It also contains an exclusions note for generalized and localized pain, as well as pain disorder exclusively attributed to psychological factors. When the medical record documentation indicates that the patient suffered an overdose of the drug, either accidental or as a suicide attempt, see the Table of Drugs and Chemicals to locate the appropriate external cause (E) code. Terms To Know 305.91 305.92 305.93 338.0 338.19 965.02 V58.69 Nondependent opioid abuse, unspecified Nondependent opioid abuse, continuous Nondependent opioid abuse, episodic Nondependent opioid abuse, in remission Other, mixed, or unspecified nondependent drug abuse, unspecified Other, mixed, or unspecified nondependent drug abuse, continuous Other, mixed, or unspecified nondependent drug abuse, episodic Other, mixed, or unspecified nondependent drug abuse, in remission Central pain syndrome — (Use additional code to identify pain associated with psychological factors: 307.89) Other acute pain — (Use additional code to identify pain associated with psychological factors: 307.89) Poisoning by methadone — (Use additional code to specify the effects of poisoning) Long-term (current) use of other medications Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. quantitative. To determine the amount and nature of the components of a substance. specimen. Tissue cells or sample of fluid taken for analysis, pathologic examination, and diagnosis. venipuncture. Piercing a vein through the skin by a needle and syringe or sharp-ended cannula or catheter to draw blood, start an intravenous infusion, instill medication, or inject another substance such as radiopaque dye. ICD-9-CM Diagnostic Codes 292.89 297.9 298.9 304.00 304.01 304.02 304.03 304.90 Other specified drug-induced mental disorder — (Use additional code for any associated drug dependence: 304.0-304.9. Use additional E code to identify drug) Unspecified paranoid state — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Unspecified psychosis — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Opioid type dependence, unspecified Opioid type dependence, continuous Opioid type dependence, episodic Opioid type dependence, in remission Unspecified drug dependence, unspecified Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 82654........................ 0.00 0.00 0.00 0.00 0.00 0.00 114 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 82690 82690 305.93 Ethchlorvynol Explanation This test may be requested as Placidyl quantitative analysis. Ethchlorvynol is a non-barbiturate sedative and hypnotic. Method is gas-liquid chromatography (GLC) or colorimetry. This test measures (quantitates) the amount of the drug present. Coding Tips Qualitative analysis should be identified using the appropriate code from range 80100–80103. Codes in categories 304 Drug dependence, and 305 Nondependent use of drugs, are reported using fifth-digit subclassifications that more specifically describe the episode of abuse. These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission. When the medical record documentation indicates that the patient suffered an overdose of the drug, either accidental or as a suicide attempt, see the Table of Drugs and Chemicals to locate the appropriate external cause (E) code. 307.41 307.42 780.52 967.8 V58.69 Other, mixed, or unspecified nondependent drug abuse, in remission Transient disorder of initiating or maintaining sleep Persistent disorder of initiating or maintaining sleep Insomnia, unspecified Poisoning by other sedatives and hypnotics — (Use additional code to specify the effects of poisoning) Long-term (current) use of other medications Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. Terms To Know qualitative. To determine the nature of the component of substance. quantitative. To determine the amount and nature of the components of a substance. specimen. Tissue cells or sample of fluid taken for analysis, pathologic examination, and diagnosis. venipuncture. Piercing a vein through the skin by a needle and syringe or sharp-ended cannula or catheter to draw blood, start an intravenous infusion, instill medication, or inject another substance such as radiopaque dye. ICD-9-CM Diagnostic Codes 304.10 304.11 304.12 304.13 304.90 305.40 305.41 305.42 305.43 305.90 305.91 305.92 Sedative, hypnotic or anxiolytic dependence, unspecified Sedative, hypnotic or anxiolytic dependence, continuous Sedative, hypnotic or anxiolytic dependence, episodic Sedative, hypnotic or anxiolytic dependence, in remission Unspecified drug dependence, unspecified Nondependent sedative, hypnotic or anxiolytic abuse, unspecified Nondependent sedative hypnotic or anxiolytic abuse, continuous Nondependent sedative, hypnotic or anxiolytic abuse, episodic Nondependent sedative, hypnotic or anxiolytic abuse, in remission Other, mixed, or unspecified nondependent drug abuse, unspecified Other, mixed, or unspecified nondependent drug abuse, continuous Other, mixed, or unspecified nondependent drug abuse, episodic Work Value 82690........................ 0.00 © 2014 OptumInsight, Inc. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.00 0.00 0.00 0.00 0.00 CPT © 2014 American Medical Association. All Rights Reserved. 115 Procedure Codes Coding and Payment Guide for Behavioral Health Services 82742 82742 305.92 305.93 Flurazepam Explanation This test may be requested as Dalmane, quantitative analysis. Flurazepam is a benzodiazepine with sedative and hypnotic effects. Method is gas chromatography (GC), gas chromatography-mass spectrometry (GC-MS), high performance liquid chromatography (HPLC), or thin layer chromatography (TLC). This test measures (quantitates) the amount of the drug present. 307.41 307.42 780.52 967.8 V58.69 V70.4 Coding Tips Qualitative analysis should be identified using the appropriate code from range 80100-80103. Codes in categories 304 Drug dependence, and 305 Nondependent use of drugs are reported using fifth-digit subclassifications that more specifically describe the episode of abuse. These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission. When the medical record documentation indicates that the patient suffered an overdose of the drug, either accidental or as a suicide attempt, see the Table of Drugs and Chemicals to locate the appropriate external cause (E) code. V72.60 Other, mixed, or unspecified nondependent drug abuse, episodic Other, mixed, or unspecified nondependent drug abuse, in remission Transient disorder of initiating or maintaining sleep Persistent disorder of initiating or maintaining sleep Insomnia, unspecified Poisoning by other sedatives and hypnotics — (Use additional code to specify the effects of poisoning) Long-term (current) use of other medications Examination for medicolegal reason — (Use additional code(s) to identify any special screening examination(s) performed: V73.0-V82.9) Laboratory examination, unspecified Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. Terms To Know specimen. Tissue cells or sample of fluid taken for analysis, pathologic examination, and diagnosis. venipuncture. Piercing a vein through the skin by a needle and syringe or sharp-ended cannula or catheter to draw blood, start an intravenous infusion, instill medication, or inject another substance such as radiopaque dye. ICD-9-CM Diagnostic Codes 304.10 304.11 304.12 304.13 304.90 304.91 304.92 304.93 305.40 305.41 305.42 305.43 305.90 305.91 Sedative, hypnotic or anxiolytic dependence, unspecified Sedative, hypnotic or anxiolytic dependence, continuous Sedative, hypnotic or anxiolytic dependence, episodic Sedative, hypnotic or anxiolytic dependence, in remission Unspecified drug dependence, unspecified Unspecified drug dependence, continuous Unspecified drug dependence, episodic Unspecified drug dependence, in remission Nondependent sedative, hypnotic or anxiolytic abuse, unspecified Nondependent sedative hypnotic or anxiolytic abuse, continuous Nondependent sedative, hypnotic or anxiolytic abuse, episodic Nondependent sedative, hypnotic or anxiolytic abuse, in remission Other, mixed, or unspecified nondependent drug abuse, unspecified Other, mixed, or unspecified nondependent drug abuse, continuous Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 82742........................ 0.00 0.00 0.00 0.00 0.00 0.00 116 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 82980 82980 305.93 Glutethimide Explanation This test may be requested as Doriden level. Glutethimide is a nonbarbiturate similar to phenobarbital and used as a sedative and hypnotic. Method is gas-liquid chromatography (GLC), high performance liquid chromatography (HPLC), or gas chromatography-mass spectrometry (GC-MS). The test measures (quantifies) the amount of the drug. Coding Tips Qualitative analysis should be identified using the appropriate code from range 80100-80103. Codes in categories 304 Drug dependence, and 305 Nondependent use of drugs, are reported using fifth-digit subclassifications that more specifically describe the episode of abuse. These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission. When the medical record documentation indicates that the patient suffered an overdose of the drug, either accidental or as a suicide attempt, see the Table of Drugs and Chemicals to locate the appropriate external cause (E) code. 307.40 307.41 307.42 307.47 307.48 780.97 967.5 967.8 V58.69 Other, mixed, or unspecified nondependent drug abuse, in remission Nonorganic sleep disorder, unspecified Transient disorder of initiating or maintaining sleep Persistent disorder of initiating or maintaining sleep Other dysfunctions of sleep stages or arousal from sleep Repetitive intrusions of sleep Altered mental status Poisoning by glutethimide group — (Use additional code to specify the effects of poisoning) Poisoning by other sedatives and hypnotics — (Use additional code to specify the effects of poisoning) Long-term (current) use of other medications Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. Terms To Know specimen. Tissue cells or sample of fluid taken for analysis, pathologic examination, and diagnosis. venipuncture. Piercing a vein through the skin by a needle and syringe or sharp-ended cannula or catheter to draw blood, start an intravenous infusion, instill medication, or inject another substance such as radiopaque dye. ICD-9-CM Diagnostic Codes 304.10 304.11 304.12 304.13 304.90 305.40 305.41 305.42 305.43 305.90 305.91 305.92 Sedative, hypnotic or anxiolytic dependence, unspecified Sedative, hypnotic or anxiolytic dependence, continuous Sedative, hypnotic or anxiolytic dependence, episodic Sedative, hypnotic or anxiolytic dependence, in remission Unspecified drug dependence, unspecified Nondependent sedative, hypnotic or anxiolytic abuse, unspecified Nondependent sedative hypnotic or anxiolytic abuse, continuous Nondependent sedative, hypnotic or anxiolytic abuse, episodic Nondependent sedative, hypnotic or anxiolytic abuse, in remission Other, mixed, or unspecified nondependent drug abuse, unspecified Other, mixed, or unspecified nondependent drug abuse, continuous Other, mixed, or unspecified nondependent drug abuse, episodic Work Value 82980........................ 0.00 © 2014 OptumInsight, Inc. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.00 0.00 0.00 0.00 0.00 CPT © 2014 American Medical Association. All Rights Reserved. 117 Procedure Codes Coding and Payment Guide for Behavioral Health Services 83805 83805 305.42 305.43 Meprobamate 305.90 Explanation This test is performed to provide therapeutic monitoring and toxicity evaluation of this antianxiety agent (numerous trade names exist, including Equanil and Meprospan). Method used is gas-liquid chromatography or high performance liquid chromatography. Quantitative measurement may be taken for numerous reasons. 305.91 305.92 305.93 Coding Tips Qualitative analysis should be identified using the appropriate code from range 80100–80103. To report the professional services for drug management, see HCPCS Level II code M0064, CPT code 90863, the appropriate level of E/M service, or the appropriate psychotherapy with E/M service code. Follow third-party payer guidelines when selecting the appropriate code for these services. Codes in categories 304 Drug dependence, and 305 Nondependent use of drugs, are reported using fifth-digit subclassifications that more specifically describe the episode of abuse. These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission. When the medical record documentation indicates that the patient suffered an overdose of the drug, either accidental or as a suicide attempt, see the Table of Drugs and Chemicals to locate the appropriate external cause (E) code. Terms To Know quantitative. To determine the amount and nature of the components of a substance. therapeutic. Act meant to alleviate a medical or mental condition. venipuncture. Piercing a vein through the skin by a needle and syringe or sharp-ended cannula or catheter to draw blood, start an intravenous infusion, instill medication, or inject another substance such as radiopaque dye. 780.97 969.5 V58.69 V70.4 V72.60 Nondependent sedative, hypnotic or anxiolytic abuse, episodic Nondependent sedative, hypnotic or anxiolytic abuse, in remission Other, mixed, or unspecified nondependent drug abuse, unspecified Other, mixed, or unspecified nondependent drug abuse, continuous Other, mixed, or unspecified nondependent drug abuse, episodic Other, mixed, or unspecified nondependent drug abuse, in remission Altered mental status Poisoning by other tranquilizers — (Use additional code to specify the effects of poisoning) Long-term (current) use of other medications Examination for medicolegal reason — (Use additional code(s) to identify any special screening examination(s) performed: V73.0-V82.9) Laboratory examination, unspecified Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. ICD-9-CM Diagnostic Codes 300.00 300.01 300.02 300.09 304.10 304.11 304.12 304.13 304.90 304.91 304.92 304.93 305.40 305.41 Anxiety state, unspecified Panic disorder without agoraphobia Generalized anxiety disorder Other anxiety states Sedative, hypnotic or anxiolytic dependence, unspecified Sedative, hypnotic or anxiolytic dependence, continuous Sedative, hypnotic or anxiolytic dependence, episodic Sedative, hypnotic or anxiolytic dependence, in remission Unspecified drug dependence, unspecified Unspecified drug dependence, continuous Unspecified drug dependence, episodic Unspecified drug dependence, in remission Nondependent sedative, hypnotic or anxiolytic abuse, unspecified Nondependent sedative hypnotic or anxiolytic abuse, continuous Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 83805........................ 0.00 0.00 0.00 0.00 0.00 0.00 118 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 83840 83840 305.50 305.51 305.52 305.53 305.90 Methadone Explanation This test is used to measure toxicity and the determination of methadone in the system in cases of drug abuse. The specimen is a random urine sample. Methods for screening purposes are thin-layer chromatography and enzyme immunoassay; for confirmation, gas chromatography/mass spectrometry. This agent is widely used in the detoxification of opiate addicts. Coding Tips Qualitative analysis should be identified using the appropriate code from range 80100-80103. Codes in categories 304 Drug dependence, and 305 Nondependent use of drugs, are reported using fifth-digit subclassifications that more specifically describe the episode of abuse. These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission. This drug may also be used in the treatment of pain. ICD-9-CM category 338 Pain, not elsewhere classified, provides subclassification codes that enable reporting of specific underlying causes of pain, as well as its acuity or chronicity. Category 338 contains an instructional note to coders to use an additional code (307.89) to identify pain associated with psychological factors. It also contains an exclusions note for generalized and localized pain, as well as pain disorder exclusively attributed to psychological factors. When the medical record documentation indicates that the patient suffered an overdose of the drug, either accidental or as a suicide attempt, see the Table of Drugs and Chemicals to locate the appropriate external cause (E) code. Terms To Know qualitative. To determine the nature of the component of substance. quantitative. To determine the amount and nature of the components of a substance. specimen. Tissue cells or sample of fluid taken for analysis, pathologic examination, and diagnosis. 305.91 305.92 305.93 338.4 965.02 965.09 V58.69 V70.4 V72.60 Nondependent opioid abuse, unspecified Nondependent opioid abuse, continuous Nondependent opioid abuse, episodic Nondependent opioid abuse, in remission Other, mixed, or unspecified nondependent drug abuse, unspecified Other, mixed, or unspecified nondependent drug abuse, continuous Other, mixed, or unspecified nondependent drug abuse, episodic Other, mixed, or unspecified nondependent drug abuse, in remission Chronic pain syndrome — (Use additional code to identify pain associated with psychological factors: 307.89) Poisoning by methadone — (Use additional code to specify the effects of poisoning) Poisoning by opiates and related narcotics, other — (Use additional code to specify the effects of poisoning) Long-term (current) use of other medications Examination for medicolegal reason — (Use additional code(s) to identify any special screening examination(s) performed: V73.0-V82.9) Laboratory examination, unspecified Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. ICD-9-CM Diagnostic Codes 292.89 297.9 298.9 304.00 304.01 304.02 304.03 304.90 Other specified drug-induced mental disorder — (Use additional code for any associated drug dependence: 304.0-304.9. Use additional E code to identify drug) Unspecified paranoid state — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Unspecified psychosis — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Opioid type dependence, unspecified Opioid type dependence, continuous Opioid type dependence, episodic Opioid type dependence, in remission Unspecified drug dependence, unspecified Work Value 83840........................ 0.00 © 2014 OptumInsight, Inc. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.00 0.00 0.00 0.00 0.00 CPT © 2014 American Medical Association. All Rights Reserved. 119 Procedure Codes Coding and Payment Guide for Behavioral Health Services 83925 83925 Opiate(s), drug and metabolites, each procedure Explanation Test methods include thin-layer chromatography, enzyme immunoassay, gas chromatography, and high performance liquid chromatography. This test measures the amount of a given opiate present and may be ordered to measure toxicity or possible drug abuse of opiates, such as morphine and meperidine (Demerol). Report 83925 for each test procedure for drugs and metabolites. 304.90 305.50 305.51 305.52 305.53 305.90 305.91 305.92 305.93 Coding Tips Qualitative analysis should be identified using the appropriate code from range 80100-80103. Codes in categories 304 Drug dependence, and 305 Nondependent use of drugs, are reported using fifth-digit subclassifications that more specifically describe the episode of abuse. These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission. This laboratory study tests for drugs that may be used in the treatment of pain. ICD-9-CM category 338 Pain, not elsewhere classified, provides subclassification codes that enable reporting of specific underlying causes of pain, as well as its acuity or chronicity. Category 338 contains an instructional note to coders to use an additional code (307.89) to identify pain associated with psychological factors. It also contains an exclusions note for generalized and localized pain, as well as pain disorder exclusively attributed to psychological factors. When the medical record documentation indicates that the patient suffered an overdose of the drug, either accidental or as a suicide attempt, see the Table of Drugs and Chemicals to locate the appropriate external cause (E) code. 338.4 965.09 V58.69 Unspecified drug dependence, unspecified Nondependent opioid abuse, unspecified Nondependent opioid abuse, continuous Nondependent opioid abuse, episodic Nondependent opioid abuse, in remission Other, mixed, or unspecified nondependent drug abuse, unspecified Other, mixed, or unspecified nondependent drug abuse, continuous Other, mixed, or unspecified nondependent drug abuse, episodic Other, mixed, or unspecified nondependent drug abuse, in remission Chronic pain syndrome — (Use additional code to identify pain associated with psychological factors: 307.89) Poisoning by opiates and related narcotics, other — (Use additional code to specify the effects of poisoning) Long-term (current) use of other medications Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. Terms To Know qualitative. To determine the nature of the component of substance. quantitative. To determine the amount and nature of the components of a substance. specimen. Tissue cells or sample of fluid taken for analysis, pathologic examination, and diagnosis. ICD-9-CM Diagnostic Codes 292.89 297.9 298.9 304.00 304.01 304.02 304.03 Other specified drug-induced mental disorder — (Use additional code for any associated drug dependence: 304.0-304.9. Use additional E code to identify drug) Unspecified paranoid state — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Unspecified psychosis — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Opioid type dependence, unspecified Opioid type dependence, continuous Opioid type dependence, episodic Opioid type dependence, in remission Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 83925........................ 0.00 0.00 0.00 0.00 0.00 0.00 120 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 83992 83992 305.92 305.93 Phencyclidine (PCP) 968.3 Explanation This test is performed to evaluate the presence of phencyclidine (also known as PCP, or angel dust), an illegal street drug. Methodology may include immunoassay, thin-layer chromatography (TLC), gas chromatography (GC), and gas chromatography/mass spectrometry (GC/TC), which quantifies the amount of drug. Coding Tips Qualitative analysis should be identified using the appropriate code from range 80100-80103. Codes in categories 304 Drug dependence, and 305 Nondependent use of drugs, are reported using fifth-digit subclassifications that more specifically describe the episode of abuse. These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission. When the medical record documentation indicates that the patient suffered an overdose of the drug, either accidental or as a suicide attempt, see the Table of Drugs and Chemicals to locate the appropriate external cause (E) code. V70.4 V72.62 Other, mixed, or unspecified nondependent drug abuse, episodic Other, mixed, or unspecified nondependent drug abuse, in remission Poisoning by intravenous anesthetics — (Use additional code to specify the effects of poisoning) Examination for medicolegal reason — (Use additional code(s) to identify any special screening examination(s) performed: V73.0-V82.9) Laboratory examination ordered as part of a routine general medical examination Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. Terms To Know assay. Test of purity. CLIA. Clinical Laboratory Improvement Amendments. Requirements set in 1988, CLIA imposes varying levels of federal regulations on clinical procedures. Few laboratories, including those in physician offices, are exempt. Adopted by Medicare and Medicaid, CLIA regulations redefine laboratory testing in regard to laboratory certification and accreditation, proficiency testing, quality assurance, personnel standards, and program administration. qualitative. To determine the nature of the component of substance. quantitative. To determine the amount and nature of the components of a substance. ICD-9-CM Diagnostic Codes 292.89 297.9 298.9 304.60 304.61 304.62 304.63 305.90 305.91 Other specified drug-induced mental disorder — (Use additional code for any associated drug dependence: 304.0-304.9. Use additional E code to identify drug) Unspecified paranoid state — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Unspecified psychosis — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Other specified drug dependence, unspecified Other specified drug dependence, continuous Other specified drug dependence, episodic Other specified drug dependence, in remission Other, mixed, or unspecified nondependent drug abuse, unspecified Other, mixed, or unspecified nondependent drug abuse, continuous Work Value 83992........................ 0.00 © 2014 OptumInsight, Inc. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.00 0.00 0.00 0.00 0.00 CPT © 2014 American Medical Association. All Rights Reserved. 121 Procedure Codes Coding and Payment Guide for Behavioral Health Services 84022 84022 293.82 Phenothiazine 295.70 Explanation Derivatives of phenothiazine are numerous and most are classified as antipsychotics. A common one is Chlorpromazine. Methods may include high performance liquid chromatography (HPLC), thin-layer chromatography (TLC), gas chromatography (GC) or fluorometry for blood; thin-layer chromatography (TLC), gas-liquid chromatography (GLC), or radioimmunoassay (RIA) for urine. The test is performed to evaluate the amount of phenothiazine present. 295.71 295.72 Coding Tips Qualitative analysis should be identified using the appropriate code from range 80100–80103. To report the professional services for drug management, see HCPCS Level II code M0064, CPT code 90863, the appropriate level of E/M service, or the appropriate psychotherapy with E/M service code. Follow third-party payer guidelines when selecting the appropriate code for these services. Schizophrenia is not diagnosed unless there is characteristic disturbance of at least two of these areas: thought, perception, mood, conduct, and personality. The first axis of coding schizophrenia is to identify the type (e.g., simple, disordered, paranoid, latent, residual, etc.). Identify the course of illness with a fifth digit, as follows: 0 Unspecified, 1 Subchronic state: continuous for more than six months but less than two years, 2 Chronic state: continuous for more than two years, 3 Subchronic with acute exacerbation: continuous for more than six months but less than two years but psychotic features have resurfaced in patient who has been in residual phase, 4 Chronic with acute exacerbation: continuous for more than two years but psychotic features have resurfaced in patient who has been in residual phase and, 5 In remission: history of schizophrenia but free from symptoms, regardless of whether patient is currently on medication. When the medical record documentation indicates that the patient suffered an overdose of the drug, either accidental or as a suicide attempt, see the Table of Drugs and Chemicals to locate the appropriate external cause (E) code. ICD-9-CM Diagnostic Codes 292.11 292.12 293.0 293.1 293.81 Drug-induced psychotic disorder with delusions — (Use additional code for any associated drug dependence: 304.0-304.9. Use additional E code to identify drug) Drug-induced psychotic disorder with hallucinations — (Use additional code for any associated drug dependence: 304.0-304.9. Use additional E code to identify drug) Delirium due to conditions classified elsewhere — (Code first the associated physical or neurological condition) Subacute delirium — (Code first the associated physical or neurological condition) Psychotic disorder with delusions in conditions classified elsewhere — (Code first the associated physical or neurological condition) Work Value 295.73 295.74 295.75 297.1 297.3 298.0 Psychotic disorder with hallucinations in conditions classified elsewhere — (Code first the associated physical or neurological condition) Schizoaffective disorder, unspecified — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Schizoaffective disorder, subchronic — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Schizoaffective disorder, chronic — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Schizoaffective disorder, subchronic with acute exacerbation — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Schizoaffective disorder, chronic with acute exacerbation — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Schizoaffective disorder, in remission — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Delusional disorder — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Shared psychotic disorder — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Depressive type psychosis — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 84022........................ 0.00 0.00 0.00 0.00 0.00 0.00 122 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 84260 84260 Serotonin 296.35 Explanation This test may also be called 5-HT or 5-Hydroxytryptamine. The specimen is whole blood or serum or spinal fluid. Methods may include fluorometry, radioimmunoassay (RIA), and gas or liquid chromatography. This test may be performed to diagnose carcinoid syndrome and severe depression. 296.36 Coding Tips 296.51 A separately reportable lumbar puncture is performed to collect cerebrospinal fluid (CSF) specimen is reported separately, see 62270. Episodic mood disorders (classified to category 296 in ICD-9-CM) are recurrent, severe disturbances of mood accompanied by one or more of the following: delusions, perplexity, disturbed attitude to self, or disorder of perception and behavior. While subcategories identify the type (e.g., manic or major depressive, bipolar, etc.) and episodic nature (e.g., single, recurrent, etc.) of the disorder, the fifth-digit assignment identifies severity of the episode. When the medical record documentation indicates that the patient suffered an overdose of the drug, either accidental or as a suicide attempt, see the Table of Drugs and Chemicals to locate the appropriate external cause (E) code. ICD-9-CM Diagnostic Codes 296.21 296.22 296.24 296.25 296.31 296.32 296.34 84260........................ 0.00 © 2014 OptumInsight, Inc. 296.54 296.55 Major depressive disorder, single episode, mild — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, single episode, moderate — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, single episode, severe, specified as with psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, single episode, in partial or unspecified remission — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, mild — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, moderate — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, severe, specified as with psychotic behavior — (Use additional Work Value 296.52 296.56 code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, in partial or unspecified remission — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, in full remission — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, mild — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, moderate — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, severe, specified as with psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, in partial or unspecified remission — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Bipolar I disorder, most recent episode (or current) depressed, in full remission — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.00 0.00 0.00 0.00 0.00 CPT © 2014 American Medical Association. All Rights Reserved. 123 Procedure Codes Coding and Payment Guide for Behavioral Health Services 84600 84600 303.91 Volatiles (eg, acetic anhydride, carbon tetrachloride, dichloroethane, dichloromethane, diethylether, isopropyl alcohol, methanol) 303.92 Explanation This is also known as volatile toxicology, which would include testing for acetone, ethanol, isopropanol, and methanol. The specimen is serum or plasma, random urine, or gastric samples (collected by gastric lavage). Method may be gas-liquid chromatography (GLC). This test is performed to determine systemic alcohol levels and possibly as surveillance for drug abuse and to evaluate methanol and isopropanol toxicity due to ingestion, inhalation, or contact. Coding Tips To report a test for acetaldehyde, see 82000. For the determination of a blood alcohol level for medical or legal purposes, see 82055 for blood alcohol; 82075 for an alcohol breath test. When the medical record documentation indicates that the patient suffered an overdose of the drug, either accidental or as a suicide attempt, see the Table of Drugs and Chemicals to locate the appropriate external cause (E) code. lavage. Washing. specimen. Tissue cells or sample of fluid taken for analysis, pathologic examination, and diagnosis. venipuncture. Piercing a vein through the skin by a needle and syringe or sharp-ended cannula or catheter to draw blood, start an intravenous infusion, instill medication, or inject another substance such as radiopaque dye. ICD-9-CM Diagnostic Codes 303.01 303.02 303.03 303.90 Acute alcoholic intoxication, unspecified — (Use additional code to identify any associated condition: 291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2, 571.3) Acute alcoholic intoxication, continuous — (Use additional code to identify any associated condition: 291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2, 571.3) Acute alcoholic intoxication, episodic — (Use additional code to identify any associated condition: 291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2, 571.3) Acute alcoholic intoxication, in remission — (Use additional code to identify any associated condition: 291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2, 571.3) Other and unspecified alcohol dependence, unspecified — (Use additional code to identify any associated condition: 291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2, 571.3) Work Value 305.00 305.01 305.02 305.03 980.0 980.1 980.2 Terms To Know 303.00 303.93 982.3 982.8 987.8 Other and unspecified alcohol dependence, continuous — (Use additional code to identify any associated condition: 291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2, 571.3) Other and unspecified alcohol dependence, episodic — (Use additional code to identify any associated condition: 291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2, 571.3) Other and unspecified alcohol dependence, in remission — (Use additional code to identify any associated condition: 291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2, 571.3) Nondependent alcohol abuse, unspecified Nondependent alcohol abuse, continuous Nondependent alcohol abuse, episodic Nondependent alcohol abuse, in remission Toxic effect of ethyl alcohol — (Use additional code to specify the nature of the toxic effect. Use additional code to identify any associated: 291.4, 303.0, 305.0) Toxic effect of methyl alcohol — (Use additional code to specify the nature of the toxic effect) Toxic effect of isopropyl alcohol — (Use additional code to specify the nature of the toxic effect) Toxic effect of other chlorinated hydrocarbon solvents — (Use additional code to specify the nature of the toxic effect) Toxic effect of other nonpetroleum-based solvents — (Use additional code to specify the nature of the toxic effect) Toxic effect of other specified gases, fumes, or vapors — (Use additional code to specify the nature of the toxic effect) Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 84600........................ 0.00 0.00 0.00 0.00 0.00 0.00 124 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 90785 90785 ICD-9-CM Diagnostic Codes Interactive complexity (List separately in addition to the code for primary procedure) Explanation This code is reported in addition to the code for a primary psychiatric service. It is reported when the patient being treated has certain factors that increase the complexity of treatment rendered. These certain factors are limited to the following: the need to manage disruptive communication that complicates the delivery of treatment; complications involving the implementation of a treatment plan due to caregiver behavioral or emotional interference; evidence of a sentinel event with subsequent disclosure to a third party and discussion and/or reporting to the patient(s); or use of play equipment or translator to enable communication when a barrier exists. The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. IOM References 100-2,15,60.3; 100-2,15,160; 100-2,15,170; 100-3,10.3; 100-3,10.4; 100-4,12,100; 100-4,12,210; 100-4,12,210.1 CCI Version 20.0 96150-96155 Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Coding Tips As an add-on code, 90785 is not subject to multiple procedure rules. No reimbursement reduction or modifier 51 is applied. Add-on codes describe additional intraservice work associated with the primary procedure. They are performed by the same physician on the same date of service as the primary service/procedure, and must never be reported as stand-alone codes. Interactive complexity is to be reported in conjunction with psychiatric evaluation services (90791-90792), the appropriate psychotherapy code (90832, 90834, or 90837), psychotherapy with evaluation and management service (90833, 90836, 90838), or group psychotherapy service (90853). Interactive complexity should never be reported with psychotherapy for crisis (90839-90840) or an evaluation and management service that was provided without psychotherapy (90833, 90836, 90838). Documentation should clearly indicate the type of interactive methods used such as interpreter, use of play, or physical device used, and that the patient did not have the ability to communicate through normal verbal means. Other catatonic states may be covered if documentation is submitted with the claim. Coverage also includes interactive examinations of patients with primary psychiatric diagnoses, excluding dementias (ICD-9-CM codes 290.0-290.9), and sleep disorders (ICD-9-CM 307.40-307.49), and one of the following conditions: 315.31 Developmental speech or language disorder, other, 389.00-359.08 Conductive hearing loss (total), 315.39 Developmental speech or language disorder, other, 389.00-389.08 Conductive hearing loss (total), 389.2 Mixed conductive and sensorineural hearing loss (total), 389.7 Deaf mutism, not elsewhere classifiable, 389.8 Other specified forms of hearing loss, 784.3 Aphasia, 784.41, 784.41 Voice disturbance, aphonia, and 784.5 Other speech disturbance (dysarthria, dysphasia). Terms To Know interactive psychotherapy. Use of physical aids and nonverbal communication to overcome barriers to therapeutic interaction between a clinician and a patient who has not yet developed or has lost either the expressive language communication skills to explain his/her symptoms and response to treatment, or the receptive communication skills to understand the clinician if he or she were to use ordinary adult language for communication. Work Value 90785........................ 0.33 © 2014 OptumInsight, Inc. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.06 0.06 0.01 0.40 0.40 CPT © 2014 American Medical Association. All Rights Reserved. 125 Procedure Codes Coding and Payment Guide for Behavioral Health Services 90791-90792 CCI Version 20.0 90791 Psychiatric diagnostic evaluation 90792 Psychiatric diagnostic evaluation with medical services Explanation A psychiatric diagnostic evaluation is the assessment of the patient's psychosocial history, current mental status, review and ordering of diagnostic studies followed by appropriate treatment recommendations. In code 90792, additional medical services such as physical examination and prescription of pharmaceuticals, are provided in addition to the diagnostic evaluation. Interviews and communication with family members or other sources is included in these codes. 90839-90840, 90846-90847v, 90853v, 96116, 96150-96155, 97802-97804, 99201-99255, 99281-99288, 99291-99292, 99304-99310, 99315-99318, 99324-99328, 99334-99350, 99354-99360, 99363-99368, 99374-99375, 99377-99420, 99441-99496, 99605-99606, G0270-G0271, G0380-G0384, G0396-G0397, G0406-G0411v, G0425-G0427, G0442-G0447, G0459, M0064 Also not with 90792: 90791 Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Coding Tips These procedures may be performed by a physician or other qualified health care professional. Psychiatric diagnostic evaluation with or without medical services include a history, mental status, and other physical examination elements, the prescribing of medications and review and ordering of laboratory or other diagnostic testing. Check with the specific payer to determine coverage. In some cases family members, guardians, or others may be consulted instead of the patient. Communication factors that complicate the diagnostic evaluation results in the need for interactive complexity (use of play equipment, involvement of third-parties, etc.) code 90785 may be reported with these procedures. Medical record documentation should indicate the need for the interactive complexity services. Diagnostic evaluations may be reported multiple times when performed during separate encounters. These codes should not be reported on the same date of service as an evaluation and management service or a psychotherapy service (including psychotherapy for crisis). To report evaluation of psychiatric hospital records reports, psychometric and/projective testing, or other data, see code 90885. Interpretation or explanation of psychiatric or other medical examinations and procedures is reported using 90887. Health and behavior assessment/reassessment is reported using 96150–96151. Terms To Know evaluation. Dynamic process in which the dentist makes clinical judgments based on data gathered during the examination. psychosocial history. Information obtained about the patient's background regarding history of mental and physical health and social history, as well as the status of current and past employment, finances, education, religion, stress, and support networks including family and friends. ICD-9-CM Diagnostic Codes The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. IOM References 100-1,3,30; 100-1,3,30.3; 100-2,15,170; 100-2,15,270; 100-2,15,270.2; 100-2,15,270.4; 100-3,10.3; 100-4,12,100; 100-4,12,110.3; 100-4,12,190.3; 100-4,12,190.7; 100-4,12,210; 100-4,12,210.1 Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 90791........................ 3.00 90792........................ 3.25 0.63 0.67 0.51 0.55 0.11 0.11 3.74 4.03 3.62 3.91 126 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 90832-90833 90832 Psychotherapy, 30 minutes with patient and/or family member 90833 Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service (List separately in addition to the code for primary procedure) psychotherapy. Treatment for mental illness and behavioral disturbances in which the clinician establishes a professional contract with the patient and, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development. ICD-9-CM Diagnostic Codes The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. Explanation Psychotherapy is a variety of treatment techniques in which a physician or other qualified health care provider helps a patient with a mental illness or behavioral disturbance identify and alleviate any emotional disruptions, maladaptive behavioral patterns, and contributing/exacerbating factors. This treatment also involves encouraging personality growth and development through coping techniques and problem-solving skills. Report code 90832 for 16 to 37 minutes of face-to-face time spent with the patient without an additional evaluation and management (E/M) service. Report code 90833 if a separate E/M is performed during the same encounter as the 16 to 37 minutes of psychotherapy. Coding Tips These procedures may be performed by a physician or other qualified health care professional. Check with the specific payer to determine coverage. Site of service does not affect code assignment. As an add-on code, 90833 is not subject to multiple procedure rules. No reimbursement reduction or modifier 51 is applied. Add-on codes describe additional intraservice work associated with the primary procedure. They are performed by the same physician on the same date of service as the primary service/procedure, and must never be reported as stand-alone codes. The appropriate evaluation and management service should be reported in addition to code 90833. However, the time involved with performing the E/M service should not be considered when selecting the psychotherapy code. If 38–52 minutes of psychotherapy are provided, see codes 90834 or 90836. If 53 or more minutes of psychotherapy are provided, see codes 90837–90838. Psychotherapy provided for an urgent assessment and history of a crisis state, including mental status examination and disposition is reported with 90839–90840. Family psychotherapy is reported using 90846–90847. Multiple family or group psychotherapy are reported using 90849 or 90853, respectively. When it is necessary to perform interactive complexity, code 90785 may be reported separately. Documentation should clearly state the reasons requiring the interactive complexity. When performed during the same encounter, management of the patient's medication(s), including review and provision of prescription is reported separately with 90863. Do not report prolonged services (90833–90838) with code 90833. IOM References 100-1,3,30; 100-1,3,30.3; 100-2,15,60.3; 100-2,15,160; 100-2,15,170; 100-2,15,270; 100-2,15,270.2; 100-2,15,270.4; 100-3,10.3; 100-3,10.4; 100-3,130.3; 100-4,12,100; 100-4,12,110.3; 100-4,12,190.3; 100-4,12,190.7; 100-4,12,210; 100-4,12,210.1 CCI Version 20.0 36640, 90791-90792, 90839-90840, 90853v, 90867-90869v, 96116, 96150-96155, 97802-97804, 99281-99288, 99291-99292, 99354-99360, 99363-99368, 99374-99375, 99377-99429, 99605-99606, G0176-G0177, G0270-G0271, G0380-G0384v, G0396-G0397, G0409-G0411v, G0442-G0447, G0459, M0064 Also not with 90832: 99201-99255, 99304-99310, 99315-99318, 99324-99328, 99334-99350, 99441-99480, 99485-99496, G0406-G0407v Also not with 90833: 99339-99340, 99441-99496, G0406v Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Terms To Know face to face. Interaction between two parties, usually provider and patient, that occurs in the physical presence of each other. Work Value 90832........................ 1.50 90833........................ 1.50 © 2014 OptumInsight, Inc. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.25 0.29 0.23 0.28 0.06 0.06 1.81 1.85 1.79 1.84 CPT © 2014 American Medical Association. All Rights Reserved. 127 Procedure Codes Coding and Payment Guide for Behavioral Health Services 90834-90836 90834 Psychotherapy, 45 minutes with patient and/or family member 90836 Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service (List separately in addition to the code for primary procedure) psychotherapy. Treatment for mental illness and behavioral disturbances in which the clinician establishes a professional contract with the patient and, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development. ICD-9-CM Diagnostic Codes The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. Explanation Psychotherapy is a variety of treatment techniques in which a physician or other qualified health care provider helps a patient with a mental illness or behavioral disturbance identify and alleviate any emotional disruptions, maladaptive behavioral patterns, and contributing/exacerbating factors. This treatment also involves encouraging personality growth and development through coping techniques and problem-solving skills. Report code 90834 for 38 to 52 minutes of face-to-face time spent with the patient without an additional evaluation and management (E/M) service. Report code 90836 if a separate E/M is performed during the same encounter as the 38 to 52 minutes of psychotherapy. Coding Tips These procedures may be performed by a physician or other qualified health care professional. Check with the specific payer to determine coverage. Site of service does not affect code assignment. As an add-on code, 90836 is not subject to multiple procedure rules. No reimbursement reduction or modifier 51 is applied. Add-on codes describe additional intraservice work associated with the primary procedure. They are performed by the same physician on the same date of service as the primary service/procedure, and must never be reported as stand-alone codes. The appropriate evaluation and management (E/M) service should be reported in addition to code 90836. However, the time involved with performing the E/M service should not be considered when selecting the psychotherapy code. If 16–37 minutes of psychotherapy are provided, see codes 90832–90833. If 53 or more minutes of psychotherapy are provided, see codes 90837–90838. Psychotherapy provided for an urgent assessment and history of a crisis state, including mental status examination and disposition is reported with 90839–90840. Family psychotherapy is reported using 90846–90847. Multiple family or group psychotherapy are reported using 90849 or 90853, respectively. When it is necessary to perform interactive complexity, code 90785 may be reported separately. Documentation should clearly state the reasons requiring the interactive complexity. When performed during the same encounter, management of the patient's medication(s), including review and provision of prescription is reported separately with 90863. Do not report prolonged services (90833–90838) with code 90833. IOM References 100-1,3,30; 100-1,3,30.3; 100-2,15,160; 100-2,15,170; 100-2,15,270; 100-2,15,270.2; 100-2,15,270.4; 100-3,10.3; 100-3,10.4; 100-3,130.3; 100-4,12,110.3; 100-4,12,190.3; 100-4,12,190.7 CCI Version 20.0 36640, 90791-90792, 90839-90840, 90853v, 90867-90869v, 96116, 96150-96155, 97802-97804, 99281-99288, 99291-99292, 99354-99360, 99363-99368, 99374-99375, 99377-99429, 99605-99606, G0176-G0177, G0270-G0271, G0380-G0384v, G0396-G0397, G0442-G0447, G0459, M0064 Also not with 90834: 90845v, 99201-99255, 99304-99310, 99315-99318, 99324-99328, 99334-99350, 99441-99480, 99485-99496, G0406-G0411v, G0425v Also not with 90836: 99339-99340, 99441-99496, G0406-G0407v, G0409-G0411v Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Terms To Know face to face. Interaction between two parties, usually provider and patient, that occurs in the physical presence of each other. Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 90834........................ 2.00 90836........................ 1.90 0.32 0.37 0.31 0.35 0.08 0.07 2.40 2.34 2.39 2.32 128 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 90837-90838 90837 Psychotherapy, 60 minutes with patient and/or family member 90838 Psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service (List separately in addition to the code for primary procedure) psychotherapy. Treatment for mental illness and behavioral disturbances in which the clinician establishes a professional contract with the patient and, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development. ICD-9-CM Diagnostic Codes The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. Explanation Psychotherapy is a variety of treatment techniques in which a physician or other qualified health care provider helps a patient with a mental illness or behavioral disturbance identify and alleviate any emotional disruptions, maladaptive behavioral patterns, and contributing/exacerbating factors. This treatment also involves encouraging personality growth and development through coping techniques and problem-solving skills. Report code 90837 for 53 minutes or more of face-to-face time spent with the patient without an additional evaluation and management (E/M) service. Report code 90838 if a separate E/M is performed during the same encounter as the 38 to 53 minutes of psychotherapy. Coding Tips These procedures may be performed by a physician or other qualified health care professional. Check with the specific payer to determine coverage. Site of service does not affect code assignment. As an add-on code, 90838 is not subject to multiple procedure rules. No reimbursement reduction or modifier 51 is applied. Add-on codes describe additional intraservice work associated with the primary procedure. They are performed by the same physician on the same date of service as the primary service/procedure, and must never be reported as stand-alone codes. The appropriate evaluation and management service should be reported in addition to code 90838. However, the time involved with performing the E/M service should not be considered when selecting the psychotherapy code. If 16–37 minutes of psychotherapy are provided, see codes 90832–90833. When 38–52 minutes of psychotherapy are provided, see 90834 and 90836. When 90 or more minutes of psychotherapy without an evaluation and management (E/M) service is provided, report the appropriate prolonged service code 99354–99357. Psychotherapy provided for an urgent assessment and history of a crisis state, including mental status examination and disposition is reported with 90839–90840. Family psychotherapy is reported using 90846–90847. Multiple family or group psychotherapy are reported using 90849 or 90853, respectively. When it is necessary to perform interactive complexity code 90785 may be reported separately. Documentation should clearly state the reasons requiring the interactive complexity. When performed during the same encounter, management of the patient's medication(s), including review and provision of prescription is reported separately with 90863. IOM References 100-1,3,30; 100-1,3,30.3; 100-2,15,160; 100-2,15,170 CCI Version 20.0 36640, 90791-90792, 90839-90840, 90845v, 90853v, 90867-90869v, 96116, 96150-96155, 97802-97804, 99281-99288, 99291-99292, 99363-99368, 99374-99375, 99377-99429, 99605-99606, G0176-G0177, G0270-G0271, G0380-G0384v, G0396-G0397, G0406-G0411v, G0425-G0426v, G0442-G0447, G0459, M0064 Also not with 90837: 99201-99255, 99304-99310, 99315-99318, 99324-99328, 99334-99350, 99358-99360, 99441-99480, 99485, 99487-99496 Also not with 90838: 99339-99340, 99354-99360, 99441-99496 Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Terms To Know face to face. Interaction between two parties, usually provider and patient, that occurs in the physical presence of each other. Work Value 90837........................ 3.00 90838........................ 2.50 © 2014 OptumInsight, Inc. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.48 0.49 0.46 0.47 0.11 0.10 3.59 3.09 3.57 3.07 CPT © 2014 American Medical Association. All Rights Reserved. 129 Procedure Codes Coding and Payment Guide for Behavioral Health Services 90839-90840 90839 90840 IOM References 100-1,3,30; 100-1,3,30.3; 100-2,15,170; 100-3,130.3; 100-4,12,100; 100-4,12,110.3 Psychotherapy for crisis; first 60 minutes each additional 30 minutes (List separately in addition to code for primary service) Explanation Psychotherapy is a variety of treatment techniques in which a physician or other qualified health care provider helps a patient with a mental illness or behavioral disturbance identify and alleviate any emotional disruptions, maladaptive behavioral patterns, and contributing/exacerbating factors. Report these codes when the psychotherapy is urgent for a life-threatening or highly complex psychiatric crisis state in a patient in distress. Code 90839 is used for the first 30 to 74 minutes of intervention and 90840 for each additional 30 minutes. These codes include history, mental status examination, mobilization of resources and implementation treatment. CCI Version 20.0 36640, 90785, 90845-90853, 90865-90870, 90875-90889, 96116, 96150-96155, 97802-97804, 99605-99606, G0176-G0177, G0270-G0271, G0396-G0397, G0442-G0447, G0459, M0064 Also not with 90839: G0409-G0411v Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Coding Tips These procedures may be performed by a physician or other qualified health care professional. Check with the specific payer to determine coverage. Site of service does not affect code assignment. As an add-on code, 90840 is not subject to multiple procedure rules. No reimbursement reduction or modifier 51 is applied. Add-on codes describe additional intraservice work associated with the primary procedure. They are performed by the same physician on the same date of service as the primary service/procedure, and must never be reported as stand-alone codes. Documentation should indicate that psychotherapy was provided for an urgent assessment and history of a crisis state, including mental status examination, disposition, and that the patient presented in a high level of distress with a complex or life-threatening problem that required immediate attention. Time does not have to be continuous; however, it does have to be face-to-face with the patient, without distraction and without providing services to another patient during the same time period. Do not report psychiatric diagnostic evaluation codes (90791–90792) or other psychotherapy (90832–90838) with psychotherapy for crisis services. To report psychotherapy to patients who are not in a crisis situation, see 90832–90838. Family psychotherapy is reported using 90846–90847. Multiple family or group psychotherapy are reported using 90849 or 90853, respectively. Terms To Know face to face. Interaction between two parties, usually provider and patient, that occurs in the physical presence of each other. psychotherapy. Treatment for mental illness and behavioral disturbances in which the clinician establishes a professional contract with the patient and, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development. ICD-9-CM Diagnostic Codes The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 90839........................ 3.13 90840........................ 1.50 0.51 0.24 0.48 0.23 0.11 0.06 3.75 1.80 3.72 1.79 130 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 90845 90845 Psychoanalysis Explanation The therapist performs psychoanalysis by utilizing methods of intense observation and analytical skills to investigate the patient's past experiences, unconscious motivations, and internal conflicts, as well as contributing medical conditions, to discover how these pilot the patient's current behavior and emotions. The psychiatrist seeks to produce change in maladapted behavior. Psychoanalysis includes reviewing medical notes and making clinical setting arrangements, assisting the patient in further self-awareness, working through barriers, understanding self-observations, and modifying mental behavior and status while continuing to elicit more information and personal exploration. This code also includes follow-up work of documentation, content review, and peer consultation. Coding Tips Psychoanalysis is reported per day. Psychoanalysis should be differentiated from psychotherapy. Reporting this code for psychoanalysis indicates that treatment is being provided by a physician with the credentials to practice analytic therapy. For Medicare patients, psychotherapy services, including psychoanalysis, are not covered if the medical record indicates that dementia has produced a cognitive defect severe enough to prevent establishment of a relationship allowing therapy to be effective. Likewise, profound mental retardation (ICD-9-CM code 318.2) never supports the medical necessity of psychotherapy services. Codes 291.0, 291.3, and 291.81 cover the various severity of symptoms associated with alcohol withdrawal. ICD-9-CM has placed “Excludes” notes with these subcategories to alert the coder that these three codes may not be used in combination with each other. Also, the coder must use the code that describes the highest level of symptom severity exhibited by the patient. In other words, the hierarchy of severity is as follows: 291.0 Withdrawal with hallucinations, delirium, delirium tremens; 291.3 Withdrawal with hallucinosis; 291.81 Withdrawal. Idiosyncratic alcohol intoxication (291.4) excludes acute alcohol intoxication, classified to category 305 for patients not diagnosed as having alcoholism or category 303 if associated with alcoholism. Schizophrenia is not diagnosed unless there is characteristic disturbance of at least two of these areas: thought, perception, mood, conduct, and personality. The first axis of coding schizophrenia is to identify the type (e.g., simple, disordered, paranoid, latent, and residual, etc.). Identify the course of illness with a fifth digit, as follows: 0 Unspecified, 1 Subchronic state: continuous for more than six months but less than two years, 2 Chronic state: continuous for more than two years, 3 Subchronic with acute exacerbation: continuous for more than six months but less than two years but psychotic features have resurfaced in patient who has been in residual phase, 4 Chronic with acute exacerbation: continuous for more than two years but psychotic features have resurfaced in patient who has been in residual phase, 5 In remission: history of schizophrenia but free from symptoms, regardless of whether patient is currently on medication. For category 296, while subcategories identify the type (e.g., manic or major depressive, bipolar, etc.) and episodic nature (e.g., single, recurrent, Work Value 90845........................ 2.10 © 2014 OptumInsight, Inc. etc.) of the disorder, the fifth-digit assignment identifies severity of the episode: 0 Unspecified, 1 Mild, 2 Moderate, 3 Severe, without mention of psychotic behavior, 4 Severe, specified as with psychotic behavior, and 5 In partial or unspecified remission. Subcategory 302.5 Trans-sexualism may be assigned to report a patient’s sex reassignment surgery status, with the appropriate fourth-digit subclassification to specify sexual history, if known. For patients with gender identity disorder (302.85), an additional code should be reported to identify sex reassignment surgery status (302.5x), with the appropriate fourth-digit sexual history designation. Codes in categories 303 Alcohol Dependence Syndrome, 304 Drug Dependence, and 305 Nondependent Use of Drugs are reported using fifth-digit subclassifications that more specifically describe the episode of abuse. These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission. Terms To Know psychoanalysis. Specific type of psychotherapy using conscious and unconscious processes to diagnose and help patients with mild to moderate chronic psychiatric or character problems control their life. Psychoanalysis must be performed for appropriate patients in a one-on-one setting by a qualified psychotherapist (MD/DO). therapeutic. Act meant to alleviate a medical or mental condition. ICD-9-CM Diagnostic Codes The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. IOM References 100-1,3,30; 100-1,3,30.3; 100-2,15,160; 100-2,15,170; 100-3,10.3; 100-3,10.4; 100-3,130.1; 100-3,130.3; 100-4,12,110.3; 100-4,12,150; 100-4,12,160; 100-4,12,160.1; 100-4,12,170; 100-4,12,170.1 CCI Version 20.0 36640, 90791-90792, 90832-90833v, 90836v, 90846-90847v, 90865v, 96116, 96150-96155, 97802-97804, 99201-99239, 99281-99285, 99291-99292, 99304-99310, 99315-99318, 99324-99328, 99334-99337, 99341-99350, 99354-99357, 99408-99409, 99605-99606, G0176-G0177, G0270-G0271, G0380-G0384, G0396-G0397, G0406-G0408, G0425-G0427, G0442-G0447, G0459, M0064 Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.41 0.39 0.08 2.59 2.57 CPT © 2014 American Medical Association. All Rights Reserved. 131 Procedure Codes Coding and Payment Guide for Behavioral Health Services 90846-90849 90846 Family psychotherapy (without the patient present) 90847 Family psychotherapy (conjoint psychotherapy) (with patient present) 90849 Multiple-family group psychotherapy Explanation The therapist provides family psychotherapy in a setting where the care provider meets with the patient's family. The family is part of the patient evaluation and treatment process. Family dynamics as they relate to the patient’s mental status and behavior are a main focus of the sessions. Attention is also given to the impact the patient's condition has on the family, with therapy aimed at improving the interaction between the patient and family members. Report 90846 when the patient is not present. Report 90847 when the patient is present with the family; 90849 when the patient is present with his or her family as well a other patients and families. When the patient is present, continuing evaluation and drug management may be indicated. Coding Tips Determine code assignment based on if patient is present during session or not. Family psychotherapy is covered by Medicare when the primary purpose of such counseling is the treatment of the patient. It may be necessary to submit the medical record documentation to substantiate the need for family psychotherapy. Some payers require prior authorization before covering family or group therapy services. Each patient record must have patient specific documentation. Documentation should include specific participation, contributions, and reactions of each family member. See code 90853 for group psychotherapy that does not consist of multiple families. For Medicare patients, psychotherapy services are not covered if the medical record indicates that dementia has produced a cognitive defect severe enough to prevent establishment of a relationship allowing therapy to be effective. Likewise, profound mental retardation (ICD-9-CM code 318.2) never supports the medical necessity of psychotherapy services. Codes 291.0, 291.3, and 291.81 cover the various severities of symptoms associated with alcohol withdrawal. ICD-9-CM has placed “Excludes” notes with these subcategories to alert the coder that these three codes may not be used in combination with each other. Also, the coder must use the code that describes the highest level of symptom severity exhibited by the patient. In other words, the hierarchy of severity is as follows: 291.0 Withdrawal with hallucinations, delirium, delirium tremens; 291.3 Withdrawal with hallucinosis; 291.81 Withdrawal. Idiosyncratic alcohol intoxication (291.4) excludes acute alcohol intoxication, classified to category 305 for patients not diagnosed as having alcoholism or category 303 if associated with alcoholism. Schizophrenia is not diagnosed unless there is characteristic disturbance of at least two of these areas: thought, perception, mood, conduct, and personality. The first axis of coding schizophrenia is to identify the type (e.g., simple, disordered, paranoid, latent, and residual, etc.). Identify the course of illness with a fifth digit, as follows: 0 Unspecified, 1 Subchronic state: continuous for more than six months but less than two years, 2 Chronic state: continuous for more than two years, 3 Subchronic with acute exacerbation: continuous for more than six Work Value months but less than two years but psychotic features have resurfaced in patient who has been in residual phase, 4 Chronic with acute exacerbation: continuous for more than two years but psychotic features have resurfaced in patient who has been in residual phase, 5 In remission: history of schizophrenia but free from symptoms, regardless of whether patient is currently on medication. For category 296, while subcategories identify the type (e.g., manic or major depressive, bipolar, etc.) and episodic nature (e.g., single, recurrent, etc.) of the disorder, the fifth-digit assignment identifies severity of the episode: 0 Unspecified, 1 Mild, 2 Moderate, 3 Severe, without mention of psychotic behavior, 4 Severe, specified as with psychotic behavior, 5 In partial or unspecified remission. Subcategory 302.5 Trans-sexualism may be assigned to report a patient’s sex reassignment surgery status, with the appropriate fourth-digit subclassification to specify sexual history, if known. For patients with gender identity disorder (302.85), an additional code should be reported to identify sex reassignment surgery status (302.5x), with the appropriate fourth-digit sexual history designation. Codes in categories 303 Alcohol Dependence Syndrome, 304 Drug Dependence, and 305 Nondependent Use of Drugs are reported using fifth-digit subclassifications that more specifically describe the episode of abuse. These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission. ICD-9-CM Diagnostic Codes The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. IOM References 100-1,3,30; 100-1,3,30.3; 100-2,15,160; 100-3,10.3; 100-3,10.4; 100-3,130.1; 100-3,130.3; 100-4,12,110.3; 100-4,12,150; 100-4,12,160; 100-4,12,160.1; 100-4,12,170; 100-4,12,170.1 CCI Version 20.0 90865v, 90870v, 96116, 96150-96155, 97802-97804, 99201-99239, 99281-99285, 99304-99310, 99315-99318, 99324-99328, 99334-99337, 99341-99350, 99354-99357, 99408-99409, 99605-99606, G0176-G0177, G0270-G0271, G0380-G0384, G0396-G0397, G0442-G0447, M0064 Also not with 90846: 90847v Also not with 90847: 36640, G0406-G0408, G0425-G0427, G0459 Also not with 90849: 90791-90792, 90845-90847v, G0406-G0408, G0425-G0427, G0459 Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 90846........................ 2.40 90847........................ 2.50 90849........................ 0.59 0.42 0.41 0.34 0.40 0.39 0.24 0.09 0.09 0.03 2.91 3.00 0.96 2.89 2.98 0.86 132 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 90853 90853 Group psychotherapy (other than of a multiple-family group) Explanation The psychiatric treatment provider conducts psychotherapy for a group of several patients in one session. Group dynamics are explored. Emotional and rational cognitive interactions between individual persons in the group are facilitated and observed. Personal dynamics of any individual patient may be discussed within the group setting. Processes that help patients move toward emotional healing and modification of thought and behavior are used, such as facilitating improved interpersonal exchanges, group support, and reminiscing. The group may be composed of patients with separate and distinct maladaptive disorders or persons sharing some facet of a disorder. This code should be used for group psychotherapy with other patients, and not members of the patients' families. Coding Tips Report interactive complexity (90785) in addition to this service when provided during the group psychotherapy session. Some payers require prior authorization before covering family or group therapy services. If multiple family group psychotherapy is performed, see 90849. Each patient record must have patient-specific documentation that includes notations of that patient’s participation, contributions, and reactions. For Medicare patients, psychotherapy services are not covered if the medical record indicates that dementia has produced a cognitive defect severe enough to prevent establishment of a relationship allowing therapy to be effective. Likewise, profound mental retardation (ICD-9-CM code 318.2) never supports the medical necessity of psychotherapy services. Codes 291.0, 291.3, and 291.81 cover the various severities of symptoms associated with alcohol withdrawal. ICD-9-CM has placed “Excludes” notes with these subcategories to alert the coder that these three codes may not be used in combination with each other. Also, the coder must use the code that describes the highest level of symptom severity exhibited by the patient. In other words, the hierarchy of severity is as follows: 291.0 Withdrawal with hallucinations, delirium, delirium tremens; 291.3 Withdrawal with hallucinosis; 291.81 Withdrawal. Idiosyncratic alcohol intoxication (291.4) excludes acute alcohol intoxication, classified to category 305 for patients not diagnosed as having alcoholism or category 303 if associated with alcoholism. Schizophrenia is not diagnosed unless there is characteristic disturbance of at least two of these areas: thought, perception, mood, conduct, and personality. The first axis of coding schizophrenia is to identify the type (e.g., simple, disordered, paranoid, latent, and residual, etc.). Identify the course of illness with a fifth digit, as follows: 0 Unspecified, 1 Subchronic state: continuous for more than six months but less than two years, 2 Chronic state: continuous for more than two years, 3 Subchronic with acute exacerbation: continuous for more than six months but less than two years but psychotic features have resurfaced in patient who has been in residual phase, 4 Chronic with acute exacerbation: continuous for more than two years but psychotic features have resurfaced in patient who has been in residual phase, 5 In remission: history of schizophrenia but free from symptoms, regardless of whether patient is currently on medication. For category Work Value 90853........................ 0.59 © 2014 OptumInsight, Inc. 296, while subcategories identify the type (e.g., manic or major depressive, bipolar, etc.) and episodic nature (e.g., single, recurrent, etc.) of the disorder, the fifth-digit assignment identifies severity of the episode: 0 Unspecified, 1 Mild, 2 Moderate, 3 Severe, without mention of psychotic behavior, 4 Severe, specified as with psychotic behavior, 5 In partial or unspecified remission. Subcategory 302.5 Trans-sexualism may be assigned to report a patient’s sex reassignment surgery status, with the appropriate fourth-digit subclassification to specify sexual history, if known. For patients with gender identity disorder (302.85), an additional code should be reported to identify sex reassignment surgery status (302.5X), with the appropriate fourth-digit sexual history designation. Codes in categories 303 Alcohol Dependence Syndrome, 304 Drug Dependence, and 305 Nondependent Use of Drugs, are reported using fifth-digit subclassifications that more specifically describe the episode of abuse. These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission. Terms To Know cognitive. Being aware by drawing from knowledge, such as judgment, reason, perception, and memory. preauthorization. Requirement that approval for requested services be obtained before providing those services. ICD-9-CM Diagnostic Codes The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. IOM References 100-1,3,30; 100-1,3,30.3; 100-2,15,160; 100-3,10.3; 100-3,10.4; 100-3,130.1; 100-3,130.3; 100-4,12,110.3; 100-4,12,150; 100-4,12,160; 100-4,12,160.1; 100-4,12,170; 100-4,12,170.1 CCI Version 20.0 36640, 90845-90849v, 90865v, 90870v, 96116, 96150-96155, 97802-97804, 99201-99239, 99281-99285, 99291-99292, 99307-99310, 99315-99318, 99324-99328, 99334-99337, 99341-99350, 99354-99357, 99408-99409, 99605-99606, G0176-G0177, G0270-G0271, G0380-G0384, G0396-G0397, G0406-G0408, G0425-G0427, G0442-G0447, G0459, M0064 Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.12 0.10 0.03 0.74 0.72 CPT © 2014 American Medical Association. All Rights Reserved. 133 Procedure Codes Coding and Payment Guide for Behavioral Health Services 90863 90863 IOM References Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services (List separately in addition to the code for primary procedure) 100-2,15,160; 100-2,15,170; 100-3,10.3; 100-3,10.4; 100-4,12,110.3; 100-4,12,210; 100-4,12,210.1 CCI Version 20.0 96150-96155 Explanation This code describes the psychiatric services of managing the patient’s medications, including the patient’s current use of the medicines, a medical review of the benefits and treatment progression, management of side effects, and review or change of prescription. This is a pharmacologically related service and is reported in addition to non-crisis related psychotherapy when there is no other evaluation and management performed during the encounter. Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Coding Tips This procedure may be performed by a physician or other qualified health care professional. Check with the specific payer to determine coverage. Site of service does not affect code assignment. As an add-on code, 90863 is not subject to multiple procedure rules. No reimbursement reduction or modifier 51 is applied. Add-on codes describe additional intraservice work associated with the primary procedure. They are performed by the same physician on the same date of service as the primary service/procedure, and must never be reported as stand-alone codes. The appropriate psychotherapy code without E/M service (90832, 90834, or 90837) should be reported in addition to code 90838. When determining the appropriate psychotherapy code to be reported with this procedure, any time spent providing the medication management should be excluded. For example, if the patient is seen for 45 minutes, and 15 minutes is spent performing medication management, code 90832 Psychotherapy, 30 minutes with patient and/or family, and code 90863 are reported. This code should not be reported with an evaluation and management code as the service is included as part of the E/M code. Medical record documentation should include the medication prescribed, condition for which the medication is needed, dosage, directions for use, any frequent side effects, the effect the medication is having on the patient's symptoms or conditions, and any changes or continuation of medications. HCPCS Level II code M0064 should be used in lieu of 90863 when required by the payer and when the encounter is brief (usually fewer than 15 minutes) for the sole purpose of refilling the medication. Terms To Know evaluation and management. Assessment, counseling, and other services provided to a patient reported through CPT codes. psychotherapy. Treatment for mental illness and behavioral disturbances in which the clinician establishes a professional contract with the patient and, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development. ICD-9-CM Diagnostic Codes This is an add-on code. Refer to the corresponding primary procedure code for ICD-9-CM diagnosis code links. Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 90863........................ 0.00 0.00 0.00 0.00 0.00 0.00 134 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 90865 90865 Narcosynthesis for psychiatric diagnostic and therapeutic purposes (eg, sodium amobarbital (Amytal) interview) Explanation A hypnotic drug known as Amytal or sodium amobarbital is infused into the patient via an intravenous drip for psychiatric diagnostic or psychotherapeutic treatment purposes. Amytal is a hypnotic sedative used for diagnosing dissociative disorders and to treat trauma victims by accessing repressed memories, emotions, or events to facilitate healing. This is often used after other measures have failed and/or when gaining a definitive diagnosis is medically essential. A sodium Amytal interview is often conducted in an inpatient setting, to monitor the effects of the drug. The patient is in a hypnotic state, where memories, as the patient perceives them, are more confidently reviewed. These interviews are often videotaped for later discussion. Coding Tips Medical record documentation should indicate the type of medications used as well as the dosage administered in addition to the findings during the examination. Most third-party payers feel that ICD-9-CM codes 290.0–305.0 and 305.2–319 support the medical necessity of this service. This code is only to be used by physicians (MD/DO). Alcohol-induced mental disorders (category 291) are psychoses resulting from excessive alcohol consumption, usually associated with nutritional deficits. This category excludes alcoholism without psychosis, which is classified to category 303. However, when alcohol dependence or abuse results in a psychotic condition, code both the psychotic condition and the dependence (303.xx) or abuse (305.0x). Codes 291.0, 291.3, and 291.81 cover the various severity of symptoms associated with alcohol withdrawal. ICD-9-CM has placed “Excludes” notes with these subcategories to alert the coder that these three codes may not be used in combination with each other. Also, the coder must use the code that describes the highest level of symptom severity exhibited by the patient. In other words, the hierarchy of severity is as follows: 291.0 Withdrawal with hallucinations, delirium, delirium tremens; 291.3 Withdrawal with hallucinosis; 291.81 Withdrawal. Idiosyncratic alcohol intoxication (291.4) excludes acute alcohol intoxication, classified to category 305 for patients not diagnosed as having alcoholism or category 303 if associated with alcoholism. Schizophrenia is not diagnosed unless there is characteristic disturbance of at least two of these areas: thought, perception, mood, conduct, and personality. The first axis of coding schizophrenia is to identify the type (e.g., simple, disordered, paranoid, latent, and residual, etc.). Identify the course of illness with a fifth digit, as follows: 0 Unspecified, 1 Subchronic state: continuous for more than six months but less than two years, 2 Chronic state: continuous for more than two years, 3 Subchronic with acute exacerbation: continuous for more than six months but less than two years but psychotic features have resurfaced in patient who has been in residual phase, 4 Chronic with acute exacerbation: continuous for more than two years but psychotic features have resurfaced in patient who has been in residual phase, 5 In remission: history of schizophrenia but free from symptoms, regardless of whether patient is currently on medication. For category 296, while subcategories identify the type Work Value 90865........................ 2.84 © 2014 OptumInsight, Inc. (e.g., manic or major depressive, bipolar, etc.) and episodic nature (e.g., single, recurrent, etc.) of the disorder, the fifth-digit assignment identifies severity of the episode: 0 Unspecified, 1 Mild, 2 Moderate, 3 Severe, without mention of psychotic behavior, 4 Severe, specified as with psychotic behavior, and 5 In partial or unspecified remission. Subcategory 302.5 Trans-sexualism may be assigned to report a patient’s sex reassignment surgery status, with the appropriate fourth-digit subclassification to specify sexual history, if known. For patients with gender identity disorder (302.85), an additional code should be reported to identify sex reassignment surgery status (302.5x), with the appropriate fourth-digit sexual history designation. Codes in categories 303 Alcohol Dependence Syndrome, 304 Drug Dependence, and 305 Nondependent Use of Drugs are reported using fifth-digit subclassifications that more specifically describe the episode of abuse. These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission. Code 309.81 should be used to report post traumatic stress disorder (PTSD). Terms To Know amobarbital. Barbiturate causing central nervous system depression with sedative hypnotic and anticonvulsant properties as well. Amytal is the trade name. Injectable amobarbital described by HCPCS Level II code J0300 is for the parenteral drug administered by IV and is frequently used as an IV sedative preoperatively or in abreaction psychotherapy. May be sold under the brand name Amytal. therapeutic. Act meant to alleviate a medical or mental condition. ICD-9-CM Diagnostic Codes The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. IOM References 100-1,3,30; 100-1,3,30.1; 100-1,3,30.3; 100-2,15,160; 100-2,15,170; 100-4,12,150; 100-4,12,160; 100-4,12,160.1; 100-4,12,170; 100-4,12,170.1; 100-4,12,210; 100-4,12,210.1 CCI Version 20.0 90791-90792, 90832-90834v, 90836-90838v, 96116, 96150-96155, 97802-97804, 99201-99239, 99281-99285, 99291-99292, 99304-99310, 99315-99318, 99324-99328, 99334-99337, 99341-99350, 99354-99357, 99605-99606, G0270-G0271, G0380-G0384, G0406-G0408, G0425-G0427, G0444-G0447, G0459, M0064 Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 1.78 0.66 0.11 4.73 3.61 CPT © 2014 American Medical Association. All Rights Reserved. 135 Procedure Codes Coding and Payment Guide for Behavioral Health Services 90867-90869 90867 CCI Version 20.0 Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management 90868 subsequent delivery and management, per session 90869 subsequent motor threshold re-determination with delivery and management 0333T, 12001-12007, 12011-12057, 13100-13133, 13151-13153, 90845-90853v, 90865v, 90880v, 95860-95870, 95907-95913, 95925-95930, 95938-95939, 96150-96155, 99201-99255, 99281-99285, 99291-99292, 99304-99310, 99315-99318, 99324-99328, 99334-99337, 99341-99350, 99374-99375, 99377-99378, 99446-99449, 99495-99496, G0410-G0411v, G0444-G0447, G0459, M0064 Also not with 90867: 90868-90870v Also not with 90868: 90870v Explanation Transcranial magnetic stimulation (TMS) is a technique to stimulate the brain by electromagnetic induction with a coil placed on the scalp. For direct stimulation to cortical neurons, a strong magnetic field pulse is generated over the patient's scalp to activate cortical neurons in the brain and to disturb the normal operation of the brain. Report 90867 for the initial treatment session, including cortical mapping, motor threshold determination, delivery, and management. Report 90868 for each subsequent session, including delivery and management only. Report 90869 for a subsequent session in which the motor threshold is re-determined and delivery and management are performed. Also not with 90869: 90868, 90870v, 99354-99357, 99406-99407, 99455-99480, 99485 Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Coding Tips Report 90867 for the initial session and 90868 for any subsequent sessions. When subsequent redetermination is performed only 90869 should be reported. Medical record documentation should indicate the nature and extent of the transcranial magnetic stimulation (TMS) planning. Do not report 90867 in conjunction with needle EMG procedures (95860–95870) or transcranial motor stimulation of upper or lower limbs (95928, 95829 or 95839). The delivery of TMS may be reported once per session with code 90867, 90868, or 90869. When documentation supports that a significant, separately identifiable evaluation and management (E/M) service was rendered the appropriate code for the E/M service may be reported additionally. Medication management (90863) or psychotherapy (90832–90840) may also be coded separately when supported by documentation. Terms To Know depression. Disproportionate depressive state with behavior disturbance that is usually the result of a distressing experience and may include preoccupation with the psychic trauma and anxiety. schizophrenia. Fundamental disturbance of personality and characteristic distortion of thinking, often a sense of being controlled by alien forces, delusions, disturbed perception, abnormal affect out of keeping with the real situation, and auditory or visual hallucinations with fear that intimate thoughts, feelings, and acts are known by others although clear consciousness and intellectual capacity are usually maintained. ICD-9-CM Diagnostic Codes The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 90867........................ 0.00 90868........................ 0.00 90869........................ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 136 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 90870 90870 296.33 Electroconvulsive therapy (includes necessary monitoring) Explanation The treating clinician initiates a seizure using electroconvulsive therapy (ECT), most often to combat chronic or profound depression, especially psychotic or intractable manic forms and used for people who cannot take antidepressants. The clinician anesthetizes the patient with a barbiturate and a muscle relaxant. Electrodes are placed on the patient's temples and/or forehead and a measured electrical dose is applied for about a second to commence the seizure, typically lasting 30 seconds to a minute. EEG and EKG monitors follow the seizure activity and heart rhythm while the patient sleeps through the therapy. The patient awakens a few minutes later. Coding Tips According to the AMA, this code includes the management of the seizures by EEG, observation of the patient and decision making regarding further treatment. The AMA goes further stating that if the psychiatrist also administers the anesthesia for the therapy, the appropriate anesthesia code (00104) should be coded in addition. However, most third-party payers, including Medicare, will not reimburse the physician performing the procedure separately for anesthesia services. For category 296—while subcategories identify the type (e.g., manic or major depressive, bipolar, etc.) and episodic nature (e.g., single, recurrent, etc.) of the disorder, the fifth-digit assignment identifies severity of the episode: 0 Unspecified, 1 Mild, 2 Moderate, 3 Severe, without mention of psychotic behavior, 4 Severe, specified as with psychotic behavior, and 5 In partial or unspecified remission. Terms To Know chronic. Persistent, continuing, or recurring. depression. Disproportionate depressive state with behavior disturbance that is usually the result of a distressing experience and may include preoccupation with the psychic trauma and anxiety. electrode. Electric terminal specialized for a particular electrochemical reaction that acts as a medium between a body surface and another instrument, commonly termed a lead. 296.35 311 Major depressive disorder, recurrent episode, severe, without mention of psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, in partial or unspecified remission — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Depressive disorder, not elsewhere classified Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. IOM References 100-1,3,30.1; 100-2,15,160; 100-2,15,170; 100-4,12,150; 100-4,12,160; 100-4,12,160.1; 100-4,12,170; 100-4,12,170.1; 100-4,12,210; 100-4,12,210.1 CCI Version 20.0 00104, 0213T, 0216T, 0228T, 0230T, 12001-12007, 12011-12057, 13100-13133, 13151-13153, 36000, 36400-36410, 36420-36430, 36440, 36600, 36640, 37202, 43752, 51701-51703, 62310-62319, 64400-64435, 64445-64450, 64479, 64483, 64490, 64493, 64505-64530, 90791-90792, 90832-90834v, 90836-90838v, 90845v, 90865v, 90880v, 93000-93010, 93040-93042, 93318, 94002, 94200, 94250, 94680-94690, 94770, 95812-95816, 95819, 95822, 95829, 95955, 96150-96360, 96365, 96372, 96374-96376, 97802-97804, 99148-99149, 99150, 99211-99223, 99231-99255, 99291-99292, 99304-99310, 99315-99316, 99334-99337, 99347-99350, 99374-99375, 99377-99378, 99446-99449, 99495-99496, 99605-99606, G0270-G0271, G0444-G0447, G0459, M0064 Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. ICD-9-CM Diagnostic Codes 296.24 296.25 296.30 Major depressive disorder, single episode, severe, specified as with psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, single episode, in partial or unspecified remission — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, unspecified — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Work Value 90870........................ 2.50 © 2014 OptumInsight, Inc. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 2.37 0.53 0.11 4.98 3.14 CPT © 2014 American Medical Association. All Rights Reserved. 137 Procedure Codes Coding and Payment Guide for Behavioral Health Services 90875-90876 90875 90876 Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 30 minutes 45 minutes Explanation The treating clinician gives individual psychophysiological therapy by utilizing biofeedback training together with psychotherapy to modify behavior. The clinician prepares the patient with sensors that read and display skin temperature, blood pressure, muscle tension, or brain wave activity. The patient is taught how certain thought processes, stimuli, and actions affect these physiological responses. The treating clinician works with the patient to learn to recognize and manipulate these responses, to control maladapted physiological functions, through relaxation and awareness techniques. Psychotherapy is also rendered using supportive interactions, suggestion, persuasion, reality discussions, re-education, behavior modification techniques, reassurance, and the occasional aid of medication. Individual psychophysiological therapy is performed face to face with the patient. Report 90875 for sessions of 30 minutes and 90876 for sessions of 45 minutes. Coding Tips These procedures may be performed by a physician or other qualified health care professional. Check with the specific payer to determine coverage. Most third-party payers, including Medicare, do not provide coverage of biofeedback therapy when used to treat psychiatric conditions. Schizophrenia is not diagnosed unless there is characteristic disturbance of at least two of these areas: thought, perception, mood, conduct, and personality. The first axis of coding schizophrenia is to identify the type (e.g., simple, disordered, paranoid, latent, residual, etc.). Identify the course of illness with a fifth digit, as follows: 0 Unspecified, 1 Subchronic state: continuous for more than six months but less than two years, 2 Chronic state: continuous for more than two years, 3 Subchronic with acute exacerbation: continuous for more than six months but less than two years but psychotic features have resurfaced in patient who has been in residual phase, 4 Chronic with acute exacerbation: continuous for more than two years but psychotic features have resurfaced in patient who has been in residual phase, and 5 In remission: history of schizophrenia but free from symptoms, regardless of whether patient is currently on medication. For category 296, while subcategories identify the type (e.g., manic or major depressive, bipolar, etc.) and episodic nature (e.g., single, recurrent, etc.) of the disorder, the fifth-digit assignment identifies severity of the episode: 0 Unspecified, 1 Mild, 2 Moderate, 3 Severe, without mention of psychotic behavior, 4 Severe, specified as with psychotic behavior, and 5 In partial or unspecified remission. Subcategory 302.5 Trans-sexualism may be assigned to report a patient’s sex reassignment surgery status, with the appropriate fourth-digit subclassification to specify sexual history, if known. For patients with gender identity disorder (302.85), an additional code should be reported to identify sex reassignment surgery status (302.5X), with the appropriate fourth-digit sexual history designation. Codes in categories 303 Alcohol Work Value dependence syndrome, 304 Drug dependence, and 305 Nondependent use of drugs, are reported using fifth-digit subclassifications that more specifically describe the episode of abuse. These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission. Physiological malfunction arising from mental factors includes functional disturbances or interruptions due to mental or psychological causes. There is no tissue damage sustained in these conditions. If there is tissue damage, see category 306. Also excluded from this category are dissociative conversion, and factitious disorders (300.11–300.19) and specific nonpsychotic mental disorders following organic brain damage (310.0–310.9). Subcategories are organized by organ system involvement: Musculoskeletal (306.0), Respiratory (306.1), Cardiovascular (306.2), Skin (306.3), Gastrointestinal (306.4), Genitourinary (306.5), Endocrine (306.6), Organs of special sense (306.7), Other specified psychophysiological malfunction, unspecified (306.8), Unspecified psychophysiological malfunction (306.9). For subcategory 306.5, one of the following fifth-digit subclassifications must be assigned: 306.50 Psychogenic genitourinary malfunction, unspecified; 306.51 Psychogenic vaginismus; 306.52 Psychogenic dysmenorrhea; 306.53 Psychogenic dysuria; 306.59 Other. Category 307 is intended for use if the psychopathology is manifested by a single specific symptom or a group of symptoms, which are not part of an organic illness or other mental disorder classifiable elsewhere. Included in this category are the following subcategories: Stuttering (307.0), Anorexia nervosa (307.1), Tics (307.2), Stereotypic movement disorder (307.3), Specific disorders of sleep of nonorganic origin (307.4), Other and unspecified disorders of eating (307.5), Enuresis (307.6), Encopresis (307.7), Pain disorders related to psychological factors (307.8), Other and unspecified special symptoms or syndromes (307.9). Some sleep disorders are not due to a substance or known physiological or pathological condition. These disorders are classified as having a nonorganic origin (307.4X). These include conditions of psychophysiological origin, disturbance in sleep environment, paradoxical conditions that exhibit seemingly contradictable aspects and/or idiopathic conditions that are self-originated or of unknown etiology. Terms To Know psychophysiological disorders. Various physical symptoms or types of physiological malfunctions of mental origin, usually manifested in the autonomic nervous system. ICD-9-CM Diagnostic Codes The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. IOM References 100-1,3,30.1; 100-2,15,160; 100-2,15,170; 100-3,10.4; 100-4,12,150; 100-4,12,160; 100-4,12,160.1; 100-4,12,170; 100-4,12,170.1; 100-4,12,210; 100-4,12,210.1 CCI Version 20.0 96150-96155 Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 90875........................ 1.20 90876........................ 1.90 0.47 1.03 0.46 0.73 0.08 0.11 1.75 3.04 1.74 2.74 138 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 90880 90880 IOM References 100-1,3,30; 100-1,3,30.1; 100-1,3,30.3; 100-2,15,160; 100-2,15,170; 100-4,12,150; 100-4,12,160; 100-4,12,160.1; 100-4,12,170; 100-4,12,170.1; 100-4,12,210; 100-4,12,210.1 Hypnotherapy Explanation Hypnosis is used as a modality for psychotherapy. The therapist induces an altered state of consciousness, or focused attention, in the patient. While patients are in this relaxed state of heightened awareness and suggestibility, they can experience changes in the way they feel, think, and behave in response to suggestions directed to them by the hypnotherapist. This modality for psychiatric services helps the therapist to achieve an alteration in the patient’s thought and behavior patterns. Coding Tips This procedure may be performed by a physician or other qualified health care professional. Check with the specific payer to determine coverage. Most third-party payers coverage of hypnotherapy is conditional and dependent upon the condition necessitating the service. Some examples of covered conditions and their corresponding ICD-9-CM codes are: Conversion disorder (300.11), Dissociative amnesia (300.12), Dissociative fugue (300.13), Multiple personality disorders (300.14), Phobic disorders (300.20–300.29), Psychogenic pain (307.80–307.89), Stress disorder (308.0–309.9). Code 309.81 should be used to report post-traumatic stress disorder (PTSD). When hypnotherapy is used in conjunction with psychotherapy (to increase the state of suggestibility) only code 90880, hypnotherapy, should be reported. CCI Version 20.0 90791-90792, 90832-90834, 90836-90838, 90845-90853, 90865v, 96116, 96150-96155, 97802-97804, 99201-99239, 99281-99285, 99291-99292, 99304-99310, 99315-99318, 99324-99328, 99334-99337, 99341-99350, 99354-99357, 99408-99409, G0176-G0177, G0270-G0271, G0380-G0384, G0396-G0397, G0406-G0408, G0410-G0411, G0425-G0427, G0442-G0447 Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Terms To Know psychogenic fugue. Rapid onset form of dissociative hysteria characterized by an episode of wandering with the inability to recall one's prior identity, followed by a quick recovery and no recollection of events that took place during the fugue state. psychotherapy. Treatment for mental illness and behavioral disturbances in which the clinician establishes a professional contract with the patient and, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development. stress reaction, acute. Acute transient disorders of any severity and nature of emotions, consciousness, and psychomotor states (singly or in combination) that occur in individuals, without any apparent pre-existing mental disorder, in response to exceptional physical or mental stress, such as natural catastrophe or battle, and that usually subside within hours or days. stress reaction, chronic. Abnormal or maladaptive reaction with emotional or behavioral characteristics as a result of a life event or stressor that is usually temporary. ICD-9-CM Diagnostic Codes The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. Work Value 90880........................ 2.19 © 2014 OptumInsight, Inc. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.58 0.38 0.08 2.85 2.65 CPT © 2014 American Medical Association. All Rights Reserved. 139 Procedure Codes Coding and Payment Guide for Behavioral Health Services 90882 90882 Environmental intervention for medical management purposes on a psychiatric patient's behalf with agencies, employers, or institutions Explanation The clinician uses this code to report work done with agencies, employers, or institutions on a psychiatric patient's behalf in order to achieve environmental changes and interventions for managing the patient’s medical condition. Coding Tips This procedure may be performed by a physician or other qualified health care professional. Check with the specific payer to determine coverage. Medicare and most third-party payers do not reimburse for this service. Terms To Know intervention. Purposeful interaction of the physical therapist with the patient and, when appropriate, with other individuals involved in patient care, using various physical therapy procedures and techniques to produce changes in the condition. noncovered procedure. Health care treatment not reimbursable according to provisions of a given insurance policy, or in the case of Medicare, in accordance with Medicare laws and regulations. ICD-9-CM Diagnostic Codes The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. IOM References 100-2,15,170; 100-4,12,210; 100-4,12,210.1 CCI Version 20.0 96150-96155 Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 90882........................ 0.00 0.00 0.00 0.00 0.00 0.00 140 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 90885 90885 Psychiatric evaluation of hospital records, other psychiatric reports, psychometric and/or projective tests, and other accumulated data for medical diagnostic purposes Explanation The clinician reviews and evaluates the patient's hospital records, other psychiatric reports such as psychometric and projective tests, and other pertinent data for the purpose of gaining a medical diagnosis and insight into the patient's present condition. Coding Tips This procedure may be performed by a physician or other qualified health care professional. Check with the specific payer to determine coverage. This service indicates the evaluation of hospital records, other psychiatric reports, diagnostic tests, or other data to diagnosis the patient's condition. If this interpretation is provided on the day that the physician is providing other services, an E/M code may be more appropriate. In the case of an encounter where evaluation and psychotherapy were performed, the appropriate psychotherapy code that includes the E/M service should be used. Very few third-party payers provide coverage of this service. In the case of reports provided at an agency's or employer's request, a fee should be discussed and payment arrangement made prior to the rendering of the service. Codes 291.0, 291.3, and 291.81 cover the various severity of symptoms associated with alcohol withdrawal. ICD-9-CM has placed “Excludes” notes with these subcategories to alert the coder that these three codes may not be used in combination with each other. Also, the coder must use the code that describes the highest level of symptom severity exhibited by the patient. In other words, the hierarchy of severity is as follows: 291.0 Withdrawal with hallucinations, delirium, delirium tremens; 291.3 Withdrawal with hallucinosis; 291.81 Withdrawal. Idiosyncratic alcohol intoxication (291.4) excludes acute alcohol intoxication, classified to category 305 for patients not diagnosed as having alcoholism or category 303 if associated with alcoholism. Schizophrenia is not diagnosed unless there is characteristic disturbance of at least two of these areas: thought, perception, mood, conduct, and personality. The first axis of coding schizophrenia is to identify the type (e.g., simple, disordered, paranoid, latent, residual, etc.). Identify the course of illness with a fifth digit, as follows: 0 Unspecified, 1 Subchronic state: continuous for more than six months but less than two years, 2 Chronic state: continuous for more than two years, 3 Subchronic with acute exacerbation: continuous for more than six months but less than two years but psychotic features have resurfaced in patient who has been in residual phase, 4 Chronic with acute exacerbation: continuous for more than two years but psychotic features have resurfaced in patient who has been in residual phase, and 5 In remission: history of schizophrenia but free from symptoms, regardless of whether patient is currently on medication. For category 296, while subcategories identify the type (e.g., manic or major depressive, bipolar, etc.) and episodic nature (e.g., single, recurrent, etc.) of the disorder, the fifth-digit assignment identifies severity of the episode: 0 Unspecified, 1 Mild, 2 Moderate, 3 Severe, without mention of psychotic behavior, 4 Severe, specified as with psychotic behavior, and 5 In partial Work Value 90885........................ 0.97 © 2014 OptumInsight, Inc. or unspecified remission. Subcategory 302.5 Trans-sexualism may be assigned to report a patient’s sex reassignment surgery status, with the appropriate fourth-digit subclassification to specify sexual history, if known. For patients with gender identity disorder (302.85), an additional code should be reported to identify sex reassignment surgery status (302.5X), with the appropriate fourth-digit sexual history designation. Codes in categories 303 Alcohol Dependence Syndrome, 304 Drug Dependence, and 305 Nondependent Use of Drugs are reported using fifth-digit subclassifications that more specifically describe the episode of abuse. These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission. Terms To Know diagnosis. Determination or confirmation of a condition, disease, or syndrome and its implications. evaluation and management. Assessment, counseling, and other services provided to a patient reported through CPT codes. noncovered procedure. Health care treatment not reimbursable according to provisions of a given insurance policy, or in the case of Medicare, in accordance with Medicare laws and regulations. ICD-9-CM Diagnostic Codes The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. IOM References 100-1,3,30.1; 100-2,15,160; 100-2,15,170; 100-4,12,150; 100-4,12,160; 100-4,12,160.1; 100-4,12,170; 100-4,12,170.1; 100-4,12,210; 100-4,12,210.1 CCI Version 20.0 96150-96155 Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.37 0.37 0.07 1.41 1.41 CPT © 2014 American Medical Association. All Rights Reserved. 141 Procedure Codes Coding and Payment Guide for Behavioral Health Services 90887 90887 Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient Explanation The clinician interprets the results of a patient’s psychiatric and medical examinations and procedures, as well as any other pertinent recorded data, and spends time explaining the patient's condition to family members and other responsible parties involved with the patient’s care and well-being. Advice is also given as to how family members can best assist the patient. Coding Tips This procedure may be performed by a physician or other qualified health care professional. Check with the specific payer to determine coverage. This service indicates that the physician has explained to the patient’s family, care taker, or to the patient’s employer, the medical examinations, procedures, and other accumulated data performed on that patient in order to obtain the responsible parties participation and/or support in that patient's treatment. If this interpretation is provided on the day that the physician is providing other services, an E/M code may be more appropriate. In the case of an encounter where evaluation and psychotherapy were performed, the appropriate psychotherapy code that includes the E/M service should be used. It should be noted that very few third-party payers provide coverage for this service. In the case of reports provided at an agency's or employer's request, a fee should be discussed and payment arrangement made prior to the rendering of the service. Codes 291.0, 291.3, and 291.81 cover the various severity of symptoms associated with alcohol withdrawal. ICD-9-CM has placed “Excludes” notes with these subcategories to alert the coder that these three codes may not be used in combination with each other. Also, the coder must use the code that describes the highest level of symptom severity exhibited by the patient. In other words, the hierarchy of severity is as follows: 291.0 Withdrawal with hallucinations, delirium, delirium tremens; 291.3 Withdrawal with hallucinosis; 291.81 Withdrawal. Idiosyncratic alcohol intoxication (291.4) excludes acute alcohol intoxication, classified to category 305 for patients not diagnosed as having alcoholism or category 303 if associated with alcoholism. Schizophrenia is not diagnosed unless there is characteristic disturbance of at least two of these areas: thought, perception, mood, conduct, and personality. The first axis of coding schizophrenia is to identify the type (e.g., simple, disordered, paranoid, latent, residual, etc.). Identify the course of illness with a fifth digit, as follows: 0 Unspecified, 1 Subchronic state: continuous for more than six months but less than two years, 2 Chronic state: continuous for more than two years, 3 Subchronic with acute exacerbation: continuous for more than six months but less than two years but psychotic features have resurfaced in patient who has been in residual phase, 4 Chronic with acute exacerbation: continuous for more than two years but psychotic features have resurfaced in patient who has been in residual phase, and 5 In remission: history of schizophrenia but free from symptoms, regardless of whether patient is currently on medication. For category 296, while subcategories Work Value identify the type (e.g., manic or major depressive, bipolar, etc.) and episodic nature (e.g., single, recurrent, etc.) of the disorder, the fifth-digit assignment identifies severity of the episode: 0 Unspecified, 1 Mild, 2 Moderate, 3 Severe, without mention of psychotic behavior, 4 Severe, specified as with psychotic behavior, and 5 In partial or unspecified remission. Subcategory 302.5 Trans-sexualism may be assigned to report a patient’s sex reassignment surgery status, with the appropriate fourth-digit subclassification to specify sexual history, if known. For patients with gender identity disorder (302.85), an additional code should be reported to identify sex reassignment surgery status (302.5X), with the appropriate fourth-digit sexual history designation. Codes in categories 303 Alcohol Dependence Syndrome, 304 Drug Dependence, and 305 Nondependent Use of Drugs are reported using fifth-digit subclassifications that more specifically describe the episode of abuse. These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission. Terms To Know diagnosis. Determination or confirmation of a condition, disease, or syndrome and its implications. evaluation and management. Assessment, counseling, and other services provided to a patient reported through CPT codes. insurance carrier. Insurer or health plan that may underwrite, administer, or sell a range of health benefit programs. noncovered procedure. Health care treatment not reimbursable according to provisions of a given insurance policy, or in the case of Medicare, in accordance with Medicare laws and regulations. ICD-9-CM Diagnostic Codes The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. IOM References 100-1,3,30.1; 100-2,15,160; 100-2,15,170; 100-4,12,150; 100-4,12,160; 100-4,12,160.1; 100-4,12,170; 100-4,12,170.1; 100-4,12,210; 100-4,12,210.1 CCI Version 20.0 96150-96155 Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 90887........................ 1.48 0.92 0.57 0.10 2.50 2.15 142 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 90889 90889 Preparation of report of patient's psychiatric status, history, treatment, or progress (other than for legal or consultative purposes) for other individuals, agencies, or insurance carriers Explanation The clinician prepares a report on a patient's mental condition, current psychiatric status, history, treatment regimen, and progress for other physicians, agencies, or insurance carriers involved with the patient’s care, except for legal or consultative purposes. Coding Tips If this service is provided on the day the physician is provides other services, an E/M code may be more appropriate. In the case of an encounter where evaluation and psychotherapy were performed, the appropriate psychotherapy code that includes the E/M service should be used. The preparation of a report describing the patient’s psychiatric condition and status provided to agencies, insurance carriers, and other physicians (not including consultations) would be reported using 90889. However, it is not to be used when providing information for legal purposes. It should be noted that very few third-party payers provide coverage of this service. In the case of reports provided at an agency's or employer's request, a fee should be discussed and payment arrangement made prior to the rendering of the service. Codes 291.0, 291.3, and 291.81 cover the various severity of symptoms associated with alcohol withdrawal. ICD-9-CM has placed “Excludes” notes with these subcategories to alert the coder that these three codes may not be used in combination with each other. Also, the coder must use the code that describes the highest level of symptom severity exhibited by the patient. In other words, the hierarchy of severity is as follows: 291.0 Withdrawal with hallucinations, delirium, delirium tremens; 291.3 Withdrawal with hallucinosis; 291.81 Withdrawal. Idiosyncratic alcohol intoxication (291.4) excludes acute alcohol intoxication, classified to category 305 for patients not diagnosed as having alcoholism or category 303 if associated with alcoholism. Schizophrenia is not diagnosed unless there is characteristic disturbance of at least two of these areas: thought, perception, mood, conduct, and personality. The first axis of coding schizophrenia is to identify the type (e.g., simple, disordered, paranoid, latent, residual, etc.). Identify the course of illness with a fifth digit, as follows: 0 Unspecified, 1 Subchronic state: continuous for more than six months but less than two years, 2 Chronic state: continuous for more than two years, 3 Subchronic with acute exacerbation: continuous for more than six months but less than two years but psychotic features have resurfaced in patient who has been in residual phase, 4 Chronic with acute exacerbation: continuous for more than two years but psychotic features have resurfaced in patient who has been in residual phase, and 5 In remission: history of schizophrenia but free from symptoms, regardless of whether patient is currently on medication. For category 296, while subcategories identify the type (e.g., manic or major depressive, bipolar, etc.) and episodic nature (e.g., single, recurrent, etc.) of the disorder, the fifth-digit assignment identifies severity of the episode: 0 Unspecified, 1 Mild, 2 Moderate, 3 Severe, without mention of psychotic behavior, 4 Severe, specified as with psychotic behavior, and 5 In partial or Work Value 90889........................ 0.00 © 2014 OptumInsight, Inc. unspecified remission. Subcategory 302.5 Trans-sexualism may be assigned to report a patient’s sex reassignment surgery status, with the appropriate fourth-digit subclassification to specify sexual history, if known. For patients with gender identity disorder (302.85), an additional code should be reported to identify sex reassignment surgery status (302.5x), with the appropriate fourth-digit sexual history designation. Codes in categories 303 Alcohol Dependence Syndrome, 304 Drug Dependence, and 305 Nondependent Use of Drugs are reported using fifth-digit subclassifications that more specifically describe the episode of abuse. These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission. Terms To Know encounter. Direct personal contact between a patient and a physician, or other person who is authorized by state licensure law and, if applicable, by hospital staff bylaws, to order or furnish hospital services for diagnosis or treatment of the patient. evaluation and management. Assessment, counseling, and other services provided to a patient reported through CPT codes. noncovered procedure. Health care treatment not reimbursable according to provisions of a given insurance policy, or in the case of Medicare, in accordance with Medicare laws and regulations. ICD-9-CM Diagnostic Codes The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. IOM References 100-1,3,30.1; 100-2,15,160; 100-2,15,170; 100-4,12,150; 100-4,12,160; 100-4,12,170; 100-4,12,170.1; 100-4,12,210; 100-4,12,210.1 CCI Version 20.0 96150-96155 Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.00 0.00 0.00 0.00 0.00 CPT © 2014 American Medical Association. All Rights Reserved. 143 Procedure Codes Coding and Payment Guide for Behavioral Health Services 90901-90911 CCI Version 20.0 90901 Biofeedback training by any modality 90911 Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry Explanation Biofeedback trains patients to control their autonomic or involuntary nervous system responses to regulate vital signs such as heart rate, blood pressure, temperature, and muscle tension. Monitors of various types are used to indicate body responses, which the patient learns to associate with related stimuli and also control in serial sessions. This code applies to any of several modalities of biofeedback training. Biofeedback is used for treatment of conditions including high blood pressure, incontinence, Raynaud's syndrome, and anticipatory nausea due to chemotherapy. For biofeedback using any modality, see code 90901. When biofeedback is performed to help the incontinent patient gain control of the related muscles, see code 90911. 12001-12007, 12011-12057, 13100-13133, 13151-13153, 36000, 36400-36410, 36420-36430, 36440, 36600, 36640, 37202, 43752, 51701-51703, 51784-51785, 62310-62319, 64400-64435, 64445-64450, 64479, 64483, 64490, 64493, 64505-64550, 90832-90834, 90836-90839, 90845-90853, 90865, 90880, 91122, 93000-93010, 93040-93042, 93318, 94002, 94200, 94250, 94680-94690, 94770, 95812-95816, 95819, 95822, 95829, 95955, 96360, 96365, 96372, 96374-96376, 99148-99149, 99150, 99211-99223, 99231-99255, 99291-99292, 99304-99310, 99315-99316, 99334-99337, 99347-99350, 99374-99375, 99377-99378, 99446-99449, 99495-99496, G0410-G0411 Also not with 90911: 51728-51729, 90901, 95860-95864, 95867-95872, 97032, 97110-97112, 97530, 97535, 97750 Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Coding Tips If biofeedback is used to facilitate psychotherapy, see codes 90875 and 90876. Medicare provides benefits for these procedures only when medically necessary for the reeducation of specific muscle groups or for the treatment of pathological muscle conditions not able to be treated using conventional methods. Biofeedback is not covered for muscle tension and for psychosomatic conditions. Be sure to check coverage guidelines with each individual payer. Terms To Know autonomic nervous system. Portion of the nervous system that controls involuntary body functions. The fibers of the autonomic nervous system regulate the iris of the eye and the smooth-muscle action of the heart, blood vessels, lungs, glands, stomach, colon, bladder, and other visceral organs that are not under conscious control by the individual. The autonomic nerve fibers exit from the central nervous system and branch out into the sympathetic and parasympathetic nervous systems. modality (therapeutic). Broad group of agents or any physical agent applied to produce therapeutic/physiological changes to biologic tissue, including thermal, acoustic, radiant (light), mechanical, or electric energy. psychotherapy. Treatment for mental illness and behavioral disturbances in which the clinician establishes a professional contract with the patient and, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development. ICD-9-CM Diagnostic Codes The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. IOM References 100-2,16,10; 100-4,5,10.2; 100-5,5,40.7 Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 90901........................ 0.41 90911........................ 0.89 0.70 1.43 0.15 0.32 0.01 0.07 1.12 2.39 0.57 1.28 144 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 95970 95970 Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular) neurostimulator pulse generator/transmitter, without reprogramming frequency. Number of times a given service is provided during a specified time period. noncovered procedure. Health care treatment not reimbursable according to provisions of a given insurance policy, or in the case of Medicare, in accordance with Medicare laws and regulations. ICD-9-CM Diagnostic Codes 296.30 296.33 Explanation A previously placed neurostimulator pulse generator is tested to verify that it is functioning properly. The neurostimulator may be a simple or complex brain, spinal cord, or peripheral device. Functions that may be tested include rate, pulse amplitude, pulse duration, configuration of waveform, battery status, electrode selectability, output modulation, cycling, impedance, and patient compliance. This code reports testing without reprogramming of the device. 296.34 Coding Tips The vagus nerve, (tenth cranial nerve), originates in the medulla oblongata, which is part of the brain stem. For patients with chronic severe depression resistant to other treatments, stimulation of the brain by electrical impulses transmitted via the vagus nerve, called vagus nerve stimulation or VNS, can relieve the symptoms of depression. Physicians can perform an electronic analysis to evaluate the implanted device. This code is appropriate to use when the neurostimulator pulse generator/transmitter is capable of affecting up to three of the following: pulse amplitude, pulse duration, pulse frequency, eight or more electrode contacts, cycling, stimulation train duration, train spacing, number of programs, number of channels, alternating electrode polarities, dose time (stimulation parameters changing in time periods of minutes including dose lockout times), more than one clinical feature (rigidity, dyskinesia, tremor, etc.). Although Medicare provides coverage of VNS for the treatment of seizures when specific indication and limitation requirements are met, benefits for VNS for resistant depression is not covered. Check with your specific payers regarding benefits for this service. For category 296—while subcategories identify the type (e.g., manic or major depressive, bipolar, etc.) and episodic nature (e.g., single, recurrent, etc.) of the disorder, the fifth-digit assignment identifies severity of the episode: 0 Unspecified, 1 Mild, 2 Moderate, 3 Severe, without mention of psychotic behavior, 4 Severe, specified as with psychotic behavior, and 5 In partial or unspecified remission. 301.11 301.12 Major depressive disorder, recurrent episode, unspecified — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, severe, without mention of psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, severe, specified as with psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Chronic hypomanic personality disorder — (Use additional code to identify any associated neurosis or psychosis, or physical condition) Chronic depressive personality disorder — (Use additional code to identify any associated neurosis or psychosis, or physical condition) Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. IOM References 100-4,32,50 CCI Version 20.0 0282T-0285T, 0317Tv, 95972v, 95974v Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Terms To Know amplitude. Size, extent, abundance, fullness, or amount of movement. depression. Disproportionate depressive state with behavior disturbance that is usually the result of a distressing experience and may include preoccupation with the psychic trauma and anxiety. dyskinesia. Impairment of voluntary movement. electrode. Electric terminal specialized for a particular electrochemical reaction that acts as a medium between a body surface and another instrument, commonly termed a lead. Work Value 95970........................ 0.45 © 2014 OptumInsight, Inc. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 1.44 0.20 0.04 1.93 0.69 CPT © 2014 American Medical Association. All Rights Reserved. 145 Procedure Codes Coding and Payment Guide for Behavioral Health Services 95974-95975 95974 95975 ICD-9-CM Diagnostic Codes 296.30 Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude, pulse duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient compliance measurements); complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, with or without nerve interface testing, first hour complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure) Explanation A complex neurostimulator, a device that provides chronic electrical stimulation to the nerves of the central or peripheral nervous system, is implanted in the cranial nerve. The stimulation affects the pulse (amplitude, duration, frequency) to treat, for example, the tremors characteristic of Parkinson's disease. Report 95974 for the first hour of electronic analysis of a complex cranial nerve neurostimulator pulse generator/transmitter with intraoperative or subsequent programming, including nerve interface testing if applicable. Report 95975 for each additional 30 minutes. Coding Tips The vagus nerve (10th cranial nerve), originates in the medulla oblongata, which is part of the brain stem. For patients with chronic severe depression resistant to other treatments, stimulation of the brain by electrical impulses transmitted via the vagus nerve, called vagus nerve stimulation or VNS, can relieve the symptoms of depression. Physicians can perform an electronic analysis to evaluate the implanted device with or without programming. These codes are appropriate to use when the neurostimulator pulse generator/transmitter is capable of affecting four or more of the following: pulse amplitude, pulse duration, pulse frequency, eight or more electrode contacts, cycling, stimulation train duration, train spacing, number of programs, number of channels, alternating electrode polarities, dose time (stimulation parameters changing in time periods of minutes including dose lockout times), or more than one clinical feature (rigidity, dyskinesia, tremor, etc.). Although Medicare provides coverage of VNS for the treatment of seizures when specific indication and limitation requirements are met, benefits for VNS for resistant depression is not covered. Check with the specific payer to determine coverage. 296.33 296.34 301.11 301.12 Major depressive disorder, recurrent episode, unspecified — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, severe, without mention of psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Major depressive disorder, recurrent episode, severe, specified as with psychotic behavior — (Use additional code to identify any associated physical disease, injury, or condition affecting the brain with psychoses classifiable to 295-298) Chronic hypomanic personality disorder — (Use additional code to identify any associated neurosis or psychosis, or physical condition) Chronic depressive personality disorder — (Use additional code to identify any associated neurosis or psychosis, or physical condition) Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 Also not with 95974: 0317Tv Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Terms To Know amplitude. Size, extent, abundance, fullness, or amount of movement. dyskinesia. Impairment of voluntary movement. electrode. Electric terminal specialized for a particular electrochemical reaction that acts as a medium between a body surface and another instrument, commonly termed a lead. frequency. Number of times a given service is provided during a specified time period. Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 95974........................ 3.00 95975........................ 1.70 2.59 1.31 1.38 0.80 0.25 0.11 5.84 3.12 4.63 2.61 146 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 96020 96020 Neurofunctional testing selection and administration during noninvasive imaging functional brain mapping, with test administered entirely by a physician or other qualified health care professional (ie, psychologist), with review of test results and report Explanation During a separately reported functional MRI (fMRI), the physician or psychologist administers a series of tests involving language, memory, cognition, movement, and sensation, and reviews the results and reports upon them in a process called functional brain mapping. These reports identify the expected versus observed locations of brain activity documented by the fMRI as the patient performs specific tasks. Coding Tips Code 96020 should not be reported with psychological testing (96101–96103) or neurobehavioral status examination services (96116–96120). Evaluation and management services would not be reported for the same date of service. When a functional MRI is performed and the neurofunctional tests are provided by a technician or other nonphysician, nonpsychologist provider, see 70554. See 70555 when neurofunctional testing is provided by the physician or psychologist and his or her presence is required during the entire MRI. Code 70555 should not be reported except when 96020 is performed. Do not report 96020 with 70554. Neurofunctional testing should not be reported in addition to psychological testing (96101-96103) or neurobehavioral status examinations or testing (96116-96120). Terms To Know evaluation and management. Assessment, counseling, and other services provided to a patient reported through CPT codes. fMRI. Functional magnetic resonance imaging. Technique to identify which part of the brain is activated by stimulus or activity; a type of brain mapping useful prior to brain surgery and in cases of epilepsy and mental disorders. fMRI is reported with CPT codes 70554 and 70555. ICD-9-CM Diagnostic Codes The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. CCI Version 20.0 0199T, 0333T, 92558, 92585-92588, 95812-95816, 95819, 95829, 95831-95834, 95851-95852, 95860-95870, 95907-95913, 95925-95930, 95938-95940, 96101-96103, 96116, 96118-96125, 99446-99449, G0453 Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Work Value 96020........................ 0.00 © 2014 OptumInsight, Inc. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.00 0.00 0.00 0.00 0.00 CPT © 2014 American Medical Association. All Rights Reserved. 147 Procedure Codes Coding and Payment Guide for Behavioral Health Services 96101-96103 96101 96102 96103 ICD-9-CM Diagnostic Codes Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, eg, MMPI, Rorschach, WAIS), per hour of the psychologist's or physician's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, eg, MMPI and WAIS), with qualified health care professional interpretation and report, administered by technician, per hour of technician time, face-to-face Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, eg, MMPI), administered by a computer, with qualified health care professional interpretation and report The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. IOM References 100-1,3,30; 100-1,3,30.3; 100-2,15,80.2; 100-2,15,160; 100-4,12,210; 100-4,12,210.1 CCI Version 20.0 96110v, 96125, G0451v Also not with 96101: 96102-96103v Also not with 96102: 96103v Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Explanation The physician or psychologist administers and interprets the results of psychological testing. The testing in written, oral, computer, or combined formats measures personality, emotions, intellectual functioning, and psychopathology. Code 96101 applies to each hour of testing and includes both face-to-face time administering tests to the patient, as well as interpretation and preparation of the report; however, it is not used to report the interpretation of technician- or computer-administered tests. In 96102, a technician administers the test, which is interpreted and reported by a qualified health care professional. In 96103, the test is administered by computer, which is interpreted and reported by a qualified health care professional. Coding Tips These codes are used to report services provided during testing of the cognitive function of the central nervous system. Report these codes once for each hour of testing, which includes interpretation and preparation of the report. A written report must be generated. A minimum of 31 minutes must be provided before assigning one of these codes. Codes 96102 and 96103 are used when the testing is preformed by a qualified technician or computer, respectively. It is appropriate, however, to assign code 96101 when reporting the additional time necessary for the health care provider to incorporate clinical data including data previously completed and reported by a technician- or computer-administered testing data. Terms To Know assessment. Process of collecting and studying information and data, such as test values, signs, and symptoms. cognitive. Being aware by drawing from knowledge, such as judgment, reason, perception, and memory. interpretation. Professional health care provider's review of data with a written or verbal opinion. Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 96101........................ 1.86 96102........................ 0.50 96103........................ 0.51 0.33 1.32 0.24 0.31 0.13 0.21 0.07 0.03 0.03 2.26 1.85 0.78 2.24 0.66 0.75 148 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 96110-96111 CCI Version 20.0 96110 Developmental screening, with interpretation and report, per standardized instrument form 96111 Developmental testing, (includes assessment of motor, language, social, adaptive, and/or cognitive functioning by standardized developmental instruments) with interpretation and report Also not with 96111: 90791-90792, 90832-90834, 90836-90839, 90845-90853, 90865, 90870, 90880, 92002-92014, 96101-96103v, 96110, 96118-96125, 97001-97004, 99201-99239, 99281-99285, 99291, 99304-99310, 99315-99318, 99324-99328, 99334-99337, 99341-99350, 99466-99480, 99485, G0380-G0384, G0406-G0408, G0410-G0411, G0425-G0427, G0451, G0459 Explanation The physician or other health care professional performs a developmental screening on a provider standardized form (meeting industry standards). The screening is to determine whether the patient needs additional work up for a developmental disorder or at periodic intervals throughout infancy and adolescent years. This code includes interpretation and report of the findings. Also not with 96110: 96125 Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Coding Tips Note that these codes are not time-based codes. Information obtained through the assessment testing is interpreted and a written report is generated. The interpretation and preparation of the report are included in the service. Developmental screening includes screening for conditions such as autism and behavioral and emotional disorders. Developmental testing includes the assessment of motor, language, social, adaptive, and/or cognitive function. For neuropsychological testing, see codes from range 96118–96120. For psychological testing, see codes from range 96101–96103. Terms To Know cognitive. Being aware by drawing from knowledge, such as judgment, reason, perception, and memory. motor function. Ability to learn or demonstrate skillful and efficient assumption, maintenance, modification, and control of voluntary postures and movement patterns. ICD-9-CM Diagnostic Codes The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. IOM References 100-1,3,30; 100-1,3,30.1; 100-1,3,30.3; 100-2,15,80.2; 100-2,15,230.4; 100-4,5,10.2; 100-4,12,150; 100-4,12,160; 100-4,12,170; 100-4,12,170.1 Work Value 96110........................ 0.00 96111........................ 2.60 © 2014 OptumInsight, Inc. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.22 0.88 0.22 0.68 0.01 0.15 0.23 3.63 0.23 3.43 CPT © 2014 American Medical Association. All Rights Reserved. 149 Procedure Codes Coding and Payment Guide for Behavioral Health Services 96116 96116 Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), per hour of the psychologist's or physician's time, both face-to-face time with the patient and time interpreting test results and preparing the report Explanation The physician or psychologist evaluates aspects of thinking, reasoning, and judgment to evaluate a patient's neurocognitive abilities. This code applies to each hour of examination time and includes both face-to-face time with the patient and time spent interpreting test results and preparing a report. Coding Tips Report this code once for each hour of testing, which includes interpretation and preparation of the report. A written report must be generated. A minimum of 31 minutes of testing must be provided before assigning one of these codes. For psychological testing, see codes from range 96101–96103. For neuropsychological testing, see codes from range 96118–96120. Developmental screening or testing is reported using 96110 or 96111, respectively. Terms To Know assessment. Process of collecting and studying information and data, such as test values, signs, and symptoms. cognitive. Being aware by drawing from knowledge, such as judgment, reason, perception, and memory. interpretation. Professional health care provider's review of data with a written or verbal opinion. ICD-9-CM Diagnostic Codes The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. IOM References 100-1,3,30; 100-1,3,30.3; 100-2,15,80.2; 100-2,15,270; 100-2,15,270.2; 100-2,15,270.4; 100-4,12,190.3; 100-4,12,190.7 CCI Version 20.0 96105-96111, 96125, G0451 Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 96116........................ 1.86 0.69 0.52 0.10 2.65 2.48 150 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 96118-96120 96118 IOM References Neuropsychological testing (eg, Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), per hour of the psychologist's or physician's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report 96119 Neuropsychological testing (eg, Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test), with qualified health care professional interpretation and report, administered by technician, per hour of technician time, face-to-face 96120 Neuropsychological testing (eg, Wisconsin Card Sorting Test), administered by a computer, with qualified health care professional interpretation and report 100-1,3,30; 100-1,3,30.3; 100-2,15,80.2 CCI Version 20.0 96110v, G0451v Also not with 96118: 96119-96125 Also not with 96119: 96120-96125 Also not with 96120: 96125 Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Explanation The physician or psychologist administers a series of tests in thinking, reasoning, judgment, and memory to evaluate the patient's neurocognitive abilities. Code 96118 applies to each hour of testing and includes face-to-face time administering tests to the patient, as well as interpretation and preparation of the report; however, it is not used to report the interpretation of technician- or computer-administered tests. In 96119, a technician administers the test, which is interpreted and reported by a qualified health care professional. In 96120, the test is administered by computer, which is interpreted and reported by a qualified health care professional. Coding Tips Codes 96118 and 96119 are reported per hour of service. Information obtained through the assessment testing is interpreted and a written report is generated. The interpretation and preparation of the report are included in the service. For psychological testing, see codes from range 96101–96103; for neurobehavioral testing, see code 96116; for standardized cognitive performance testing, see code 96125; for developmental screening or testing, see codes from range 96110–96111. Code 96118 is not to be reported for the interpretation and reporting or either 96119 or 96120. Code 96118 may also be reported when additional time is needed to integrate other clinical data including technician and computer-administered test results. Terms To Know assessment. Process of collecting and studying information and data, such as test values, signs, and symptoms. cognitive. Being aware by drawing from knowledge, such as judgment, reason, perception, and memory. interpretation. Professional health care provider's review of data with a written or verbal opinion. ICD-9-CM Diagnostic Codes The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. Work Value 96118........................ 1.86 96119........................ 0.55 96120........................ 0.51 © 2014 OptumInsight, Inc. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.84 1.71 0.80 0.30 0.10 0.19 0.07 0.01 0.03 2.77 2.27 1.34 2.23 0.66 0.73 CPT © 2014 American Medical Association. All Rights Reserved. 151 Procedure Codes Coding and Payment Guide for Behavioral Health Services 96125 96125 Standardized cognitive performance testing (eg, Ross Information Processing Assessment) per hour of a qualified health care professional's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report Explanation A qualified health care professional administers standardized cognitive performance testing to evaluate such factors as the patient's immediate, recent, and remote memory; temporal and spatial orientation; general information recall; problem-solving and abstract reasoning abilities; organizational skills; and auditory processing and retention. This code applies to each hour of testing and includes face-to-face time administering tests to the patient, as well as interpretation and preparation of the report. Coding Tips Report this code once for each hour of testing, which includes interpretation and preparation of the report. A written report must be generated. A minimum of 31 minutes of testing must be provided before assigning this code. For psychological testing, see codes from range 96101–96103; for neurobehavioral testing, see code 96116; for neuropsychological testing, see codes 96118–96120; for developmental screening or testing, see codes from range 96110–96111. Terms To Know cognitive. Being aware by drawing from knowledge, such as judgment, reason, perception, and memory. interpretation. Professional health care provider's review of data with a written or verbal opinion. ICD-9-CM Diagnostic Codes The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. IOM References 100-2,15,80.2; 100-2,15,160; 100-2,15,230.4; 100-4,5,10.2; 100-4,5,10.6 CCI Version 20.0 No CCI Edits apply to this code. Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 96125........................ 1.70 1.43 1.43 0.07 3.20 3.20 152 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 96150-96151 96150 96151 IOM References Health and behavior assessment (eg, health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; initial assessment re-assessment 100-1,3,30; 100-1,3,30.3; 100-2,15,270; 100-2,15,270.2; 100-2,15,270.4; 100-4,12,190.3; 100-4,12,190.7 CCI Version 20.0 96101-96111, 96116, 96118-96125, 99406-99407, G0396-G0397, G0436-G0437, G0442-G0447, G0451 Also not with 96150: 96151-96154v Explanation These codes report assessment of psychological, behavioral, emotional, cognitive, and relevant social factors that can prevent, treat, or manage physical health problems. The assessment must be associated with an acute or chronic illness, the prevention of a physical illness or disability, and the maintenance of health. The initial assessment (96150) and re-assessment (96151) apply to each 15-minute direct, face-to-face session with the patient. A reassessment (96151) is reported to obtain objective measures of goals formulated in the initial assessment and to modify plans as is indicated to support the goals. Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Coding Tips These services are used to identify the assessment of a patient’s psychological, behavioral, emotional, cognitive, and social factors as they relate to the prevention, treatment, or management of conditions affecting the patient’s physical health. These codes do not identify a service that focuses on the mental health of the patient, but rather on the biopsychosocial factors that are, or could affect the treatment of or severity of, the patient’s physical condition. These services are, however, used to modify the psychological, behavioral, emotional, cognitive, and social factors that are identified directly affecting the patient’s physiological functioning, disease status, health, and general well-being. They are offered to those patients that have established illnesses or symptoms, but who are not diagnosed with mental illness. They do not, however, represent preventive medical counseling or risk factor reduction interventions. For patients that require psychiatric services as well as health and behavior assessment/intervention, report those services using the appropriate code from the 90785–90899 or 96150–96155 range, respectively. However, do not report codes 90785–90899 and 96150–96155 on the same date of service. Report codes 96150 or 96151 for a health and behavior assessment; 96152–96155 for interventional services. Terms To Know assessment. Process of collecting and studying information and data, such as test values, signs, and symptoms. cognitive. Being aware by drawing from knowledge, such as judgment, reason, perception, and memory. intervention. Purposeful interaction of the physical therapist with the patient and, when appropriate, with other individuals involved in patient care, using various physical therapy procedures and techniques to produce changes in the condition. ICD-9-CM Diagnostic Codes The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. Work Value 96150........................ 0.50 96151........................ 0.48 © 2014 OptumInsight, Inc. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.09 0.09 0.08 0.08 0.01 0.01 0.60 0.58 0.59 0.57 CPT © 2014 American Medical Association. All Rights Reserved. 153 Procedure Codes Coding and Payment Guide for Behavioral Health Services 96152-96155 96152 ICD-9-CM Diagnostic Codes Health and behavior intervention, each 15 minutes, face-to-face; individual 96153 group (2 or more patients) 96154 family (with the patient present) 96155 family (without the patient present) The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. IOM References 100-1,3,30; 100-1,3,30.3 CCI Version 20.0 Also not with 96152: 96151v, 99406-99407, G0396-G0397, G0436-G0437, G0442-G0447 Explanation These are interventional services prescribed to modify the psychological, behavioral, emotional, cognitive, and social factors relevant to and affecting the patient's physical health problems. Each code applies to a 15-minute session of direct face-to-face intervention. Report 96152 for the initial assessment with the individual/patient only. Report 96153 for intervention attended by a group (two or more patients). Report 96154 for intervention that includes the family with the patient present. Report 96155 for intervention with the family without the patient’s presence. Also not with 96153: 96151-96152v, 96154v, 99406-99407, G0396-G0397, G0436-G0437, G0442-G0447 Also not with 96154: 96151-96152v, 99406-99407, G0396-G0397, G0436-G0437, G0442-G0447 Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Coding Tips These services are used to identify the assessment of a patient’s psychological, behavioral, emotional, cognitive, and social factors as they relate to the prevention, treatment, or management of conditions affecting the patient’s physical health. These codes do not identify a service that focuses on the mental health of the patient but rather on the biopsychosocial factors that are, or could affect the treatment of or severity of, the patient’s physical condition. These services are, however, used to modify the psychological, behavioral, emotional, cognitive, and social factors that are identified directly affecting the patient’s physiological functioning, disease status, health, and general well-being. They are offered to those patients that have established illnesses or symptoms, but who are not diagnosed with mental illness. They do not, however, represent preventive medical counseling or risk factor reduction interventions. For patients that require psychiatric services as well as health and behavior assessment/intervention, report those services using the appropriate code from the 90785–90899 or 96150–96155 range respectively. However, do not report codes 90785–90899 and 96150–96155 on the same date of service. Report codes 96150 or 96151 for a health and behavior assessment; 96152–96155 for interventional services. Terms To Know assessment. Process of collecting and studying information and data, such as test values, signs, and symptoms. cognitive. Being aware by drawing from knowledge, such as judgment, reason, perception, and memory. intervention. Purposeful interaction of the physical therapist with the patient and, when appropriate, with other individuals involved in patient care, using various physical therapy procedures and techniques to produce changes in the condition. Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 96152........................ 0.46 96153........................ 0.10 96154........................ 0.45 96155........................ 0.44 0.08 0.02 0.08 0.17 0.07 0.02 0.07 0.17 0.01 0.01 0.01 0.03 0.55 0.13 0.54 0.64 0.54 0.13 0.53 0.64 154 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 97532 97532 326 Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes Explanation A patient with inherited learning disabilities or in individuals who have lost these skills as a result of illness or brain injury is worked with on a direct, one-on-one basis to assist in the development of cognitive skills. The individual often needs to develop compensatory methods of processing and retrieving information when disability, illness, or injury has affected these cognitive processes. Cognitive skill development includes mental exercises that assist the patient in areas such as attention, memory, perception, language, reasoning, planning, problem-solving, and related skills. Coding Tips This procedure may be performed by a physician or other qualified health care professional. Check with the specific payer to determine coverage. The following is a sample of a clinical vignette for this code. A 74-year-old male presents with a combination of depression and organic brain syndrome. The patient lives with his wife but has difficulty remembering to take his medications and, according to his wife, remembering to eat. The clinician develops a structured system by which the patient incorporates taking his medication and eating meals at a set time each day as part of his daily living activities after a thorough discussion of the home environment and the couple's daily routine. 332.1 333.4 334.0 334.2 334.3 334.4 430 431 432.0 432.1 432.9 436 438.0 Terms To Know 438.10 cognitive. Being aware by drawing from knowledge, such as judgment, reason, perception, and memory. depression. Disproportionate depressive state with behavior disturbance that is usually the result of a distressing experience and may include preoccupation with the psychic trauma and anxiety. 438.11 ICD-9-CM Diagnostic Codes 294.10 294.11 294.8 294.9 Dementia in conditions classified elsewhere without behavioral disturbance — (Code first any underlying physical condition: 046.11-046.19, 094.1, 275.1, 330.1, 331.0, 331.11, 331.19, 331.82, 333.4, 340, 345.0-345.9, 446.0) Dementia in conditions classified elsewhere with behavioral disturbance — (Code first any underlying physical condition: 046.11-046.19, 094.1, 275.1, 330.1, 331.0, 331.11, 331.19, 331.82, 332.0, 333.4, 340, 345.0-345.9, 446.0)(Use additional code, where applicable, to identify: V40.31) Other persistent mental disorders due to conditions classified elsewhere — (Use additional code for associated epilepsy: 345.0-345.9) Unspecified persistent mental disorders due to conditions classified elsewhere Work Value 97532........................ 0.44 © 2014 OptumInsight, Inc. V40.0 V40.1 Late effects of intracranial abscess or pyogenic infection — (Use additional code to identify condition: 331.4, 342.0-342.9, 344.0-344.9) Secondary Parkinsonism — (Use additional E code to identify drug, if drug-induced) Huntington's chorea Friedreich's ataxia Primary cerebellar degeneration Other cerebellar ataxia — (Use additional E code to identify drug, if drug-induced) Cerebellar ataxia in diseases classified elsewhere — (Code first underlying disease: 140.0-239.9, 244.0-244.9, 303.0-303.9) Subarachnoid hemorrhage — (Use additional code to identify presence of hypertension) Intracerebral hemorrhage — (Use additional code to identify presence of hypertension) Nontraumatic extradural hemorrhage — (Use additional code to identify presence of hypertension) Subdural hemorrhage — (Use additional code to identify presence of hypertension) Unspecified intracranial hemorrhage — (Use additional code to identify presence of hypertension) Acute, but ill-defined, cerebrovascular disease — (Use additional code to identify presence of hypertension) Cognitive deficits due to cerebrovascular disease — (Use additional code to identify presence of hypertension) Unspecified speech and language deficit due to cerebrovascular disease — (Use additional code to identify presence of hypertension) Aphasia due to cerebrovascular disease — (Use additional code to identify presence of hypertension) Problems with learning Problems with communication (including speech) Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. IOM References 100-2,15,230; 100-2,15,230.1; 100-2,15,230.2; 100-2,15,230.4; 100-4,5,10 CCI Version 20.0 0213T, 0216T, 0228T-0231T, 62310-62319, 64400-64435, 64445-64450, 64479-64490, 64493, 64505-64530, 97002, 97004 Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.30 0.30 0.01 0.75 0.75 CPT © 2014 American Medical Association. All Rights Reserved. 155 Procedure Codes Coding and Payment Guide for Behavioral Health Services 97533 97533 333.4 333.5 Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes Explanation Individuals with sensory integration disorders are worked with to teach techniques for enhancing sensory processing and adapting to environmental demands. Sensory experiences include touch, movement, body awareness, sight, sound, and the pull of gravity. The process of the brain organizing and interpreting this information is called sensory integration. Sensory integration provides a crucial foundation for later, more complex learning and behavior. Sensory integration disorders may be the result of a learning disability, illness, or brain injury. Coding Tips 334.0 334.2 334.3 334.4 348.1 430 431 This procedure may be performed by a physician or other qualified health care professional. Check with the specific payer to determine coverage. The following is a sample clinical vignette for sensory integrative techniques used for this code. A child is fearful of walking down stairs, has poor balance, and difficulty focusing on the task. Evaluation revealed the patient to exhibit difficulty in processing vestibular, proprioceptive, and tactile input. The child is engaged in activities that provide the appropriate sensory input including heavy touch or pressure with graded movement in order to improve the patient’s ability to make adaptive motor and behavioral responses. This also helps the child cope with environmental demands. With the improvement in sensorimotor and perceptual skills, the patient is able to walk down stairs with less fear and better balance. The child also appears to be able to sit longer to attend to an assigned task. 432.0 Terms To Know V40.0 V40.1 sensory integration. Ability to integrate information that is derived from the environment and that relates to movement. tactile. Having or related to touch. ICD-9-CM Diagnostic Codes 294.8 294.9 330.8 330.9 331.89 332.1 Other persistent mental disorders due to conditions classified elsewhere — (Use additional code for associated epilepsy: 345.0-345.9) Unspecified persistent mental disorders due to conditions classified elsewhere Other specified cerebral degenerations in childhood — (Use additional code to identify associated intellectual disabilities) Unspecified cerebral degeneration in childhood — (Use additional code to identify associated intellectual disabilities) Other cerebral degeneration — (Use additional code, where applicable, to identify dementia: 294.10, 294.11) Secondary Parkinsonism — (Use additional E code to identify drug, if drug-induced) Work Value 432.1 432.9 436 438.0 438.10 Huntington's chorea Other choreas — (Use additional E code to identify drug, if drug-induced) Friedreich's ataxia Primary cerebellar degeneration Other cerebellar ataxia — (Use additional E code to identify drug, if drug-induced) Cerebellar ataxia in diseases classified elsewhere — (Code first underlying disease: 140.0-239.9, 244.0-244.9, 303.0-303.9) Anoxic brain damage — (Use additional E code to identify cause) Subarachnoid hemorrhage — (Use additional code to identify presence of hypertension) Intracerebral hemorrhage — (Use additional code to identify presence of hypertension) Nontraumatic extradural hemorrhage — (Use additional code to identify presence of hypertension) Subdural hemorrhage — (Use additional code to identify presence of hypertension) Unspecified intracranial hemorrhage — (Use additional code to identify presence of hypertension) Acute, but ill-defined, cerebrovascular disease — (Use additional code to identify presence of hypertension) Cognitive deficits due to cerebrovascular disease — (Use additional code to identify presence of hypertension) Unspecified speech and language deficit due to cerebrovascular disease — (Use additional code to identify presence of hypertension) Problems with learning Problems with communication (including speech) Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. IOM References 100-2,15,230; 100-2,15,230.1; 100-2,15,230.2; 100-2,15,230.4; 100-4,5,10 CCI Version 20.0 0213T, 0216T, 0228T-0231T, 62310-62319, 64400-64435, 64445-64450, 64479-64490, 64493, 64505-64530, 97002, 97004 Note: These CCI edits are used for Medicare. Other payers may reimburse on codes listed above. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 97533........................ 0.44 0.37 0.37 0.01 0.82 0.82 156 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 98960-98962 98960 Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient 98961 2-4 patients 98962 5-8 patients Explanation The qualified, nonphysician health care professional provides education and training using a standard curriculum. This training is prescribed by a physician to enable the patient to concurrently self-manage established illnesses or diseases with health care providers. Report 98960 for education and training provided for an individual patient for each 30 minutes of service. Report 98961 for a group of two to four patients and 98962 for a group of five to eight patients. Coding Tips The focus of the training should be to teach patients how to effectively manage their clinical condition. The training may also include a patient’s caregiver. The service can be provided to either a single patient (98960) or a group of patients (98961–98962). For individual counseling and education provided by a physician, see the evaluation and management codes; for group education and counseling, see code 99078. See 96150–96155 when a health and behavior assessment or intervention is provided that is not part of a standard curriculum. ICD-9-CM Diagnostic Codes The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. IOM References 100-2,15,230.4 CCI Version 20.0 No CCI Edits apply to this code. Work Value 98960........................ 0.00 98961........................ 0.00 98962........................ 0.00 © 2014 OptumInsight, Inc. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.76 0.36 0.26 0.76 0.36 0.26 0.01 0.01 0.01 0.77 0.37 0.27 0.77 0.37 0.27 CPT © 2014 American Medical Association. All Rights Reserved. 157 Procedure Codes Coding and Payment Guide for Behavioral Health Services 98966-98968 98966 IOM References Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion 98967 11-20 minutes of medical discussion 98968 21-30 minutes of medical discussion 100-2,15,230.4; 100-4,12,30.6.16 CCI Version 20.0 No CCI Edits apply to this code. Explanation A qualified health care professional (nonphysician) provides telephone assessment and management services to a patient in a non-face-to-face encounter. These episodes of care may be initiated by an established patient or by the patient's guardian. These codes are not reported if the telephone service results in a decision to see the patient within 24 hours or at the next available urgent visit appointment; instead, the phone encounter is regarded as part of the pre-service work of the subsequent face-to-face encounter. These codes are also not reported if the telephone call is in reference to a service performed and reported by the qualified health care professional that occurred within the past seven days or within the postoperative period of a previously completed procedure. This applies both to unsolicited patient follow-up or that requested by the health care professional. Report 98966 for telephone services requiring five to 10 minutes of medical discussion, 98967 for telephone services requiring 11 to 20 minutes of medical discussion, and 98968 for telephone services requiring 21 to 30 minutes of medical discussion. Do not report 98966-98968 if these codes have been reported within the previous seven days. Coding Tips Telephone services report the evaluation and management provided by the nonphysician provider to an established patient or the guardian of the established patient and must be initiated by the patient. These codes are only reported if there is no decision to see the patient within 24 hours or the next available urgent appointment, or if it does not refer to an E/M service performed and reported by the physician within seven days or within the postoperative period of the previously completed procedure. Appropriate code selection is dependent upon the time spent in discussion with the patient. Time documenting the discussion is excluded. This procedure may be performed by a physician or other qualified health care professional. Check with the specific payer to determine coverage. Terms To Know evaluation and management. Assessment, counseling, and other services provided to a patient reported through CPT codes. ICD-9-CM Diagnostic Codes The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 98966........................ 0.25 98967........................ 0.50 98968........................ 0.75 0.13 0.23 0.33 0.10 0.19 0.29 0.01 0.03 0.05 0.39 0.76 1.13 0.36 0.72 1.09 158 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc. Coding and Payment Guide for Behavioral Health Services Procedure Codes 98969 98969 Online assessment and management service provided by a qualified nonphysician health care professional to an established patient or guardian, not originating from a related assessment and management service provided within the previous 7 days, using the Internet or similar electronic communications network Explanation On-line medical assessment and management services are provided to an established patient or guardian in response to a patient's on-line inquiry utilizing Internet resources in a non-face-to-face encounter. Services must be provided by a qualified health care professional (nonphysician). In order for these services to be reportable, the health care professional must provide a personal, timely response to the inquiry and the encounter must be permanently stored via electronic means or hard copy. A reportable service includes all communication related to the on-line encounter, such as phone calls, provision of prescriptions, and orders for laboratory services. This code is not reported if the on-line evaluation is in reference to a service performed and reported by the same health care professional within the past seven days or within the postoperative period of a previously completed procedure. Rather, the on-line service is considered to be part of the previous service or procedure. This applies both to unsolicited patient follow-up or that requested by the health care professional. Report 98969 only once for the same episode of care during a seven-day period. Coding Tips This procedure may be performed by a physician or other qualified health care professional. Check with the specific payer to determine coverage. This code is not reported if the online evaluation is in reference to a service performed and reported by the same health care professional within the past seven days or within the postoperative period of a previously completed procedure. Rather, the online service is considered to be part of the previous service or procedure. This applies both to unsolicited patient follow-up or that requested by the health care professional. Report 98969 only once for the same episode of care during a seven-day period. Do not report online assessment and management services during the same month that complex chronic care coordination (99487-99489) or transitional care management services (99495-99496) are reported. ICD-9-CM Diagnostic Codes The application of this code is too broad to adequately present ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book. IOM References 100-2,15,230.4 CCI Version 20.0 No CCI Edits apply to this code. Work Value 98969........................ 0.00 © 2014 OptumInsight, Inc. Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 0.00 0.00 0.00 0.00 0.00 CPT © 2014 American Medical Association. All Rights Reserved. 159 Procedure Codes Coding and Payment Guide for Behavioral Health Services 99510 99510 Home visit for individual, family, or marriage counseling Explanation A nonphysician home health professional makes an initial visit to the home to evaluate specific needs. If home health care would be of benefit, a plan of care is developed based on medical orders from the patient's provider. For example, a plan might specify one or more visits from a therapist. The provider regularly reviews progress reports. Coding Tips This code is for use by the nonphysician provider. For physician services, see the evaluation and management home visits (99341–99350), individual psychotherapy (90804–90815), family psychotherapy (90846–90847), and group psychotherapy (90853) codes. Those nonphysician providers who may report E/M codes may report an E/M service with this code when the E/M service is significant and separately identifiable. Medical record documentation must support the use of both codes. Terms To Know counseling. Discussion with a patient and/or family concerning one or more of the following areas: diagnostic results, impressions, and/or recommended diagnostic studies; prognosis; risks and benefits of management (treatment) options; instructions for management (treatment) and/or follow-up; importance of compliance with chosen management (treatment) options; risk factor reduction; and patient and family education. ICD-9-CM Diagnostic Codes V62.81 V62.82 V62.89 V62.9 V65.40 V65.42 V65.44 V65.45 V65.49 Interpersonal problem, not elsewhere classified Bereavement, uncomplicated Other psychological or physical stress, not elsewhere classified Unspecified psychosocial circumstance Counseling NOS Counseling on substance use and abuse Human immunodeficiency virus (HIV) counseling Counseling on other sexually transmitted diseases Other specified counseling Please note that this list of associated ICD-9-CM codes is not all-inclusive. The procedure may be performed for reasons other than those listed that support the medical necessity of the service. Only those conditions supported by the medical record documentation should be reported. CCI Version 20.0 No CCI Edits apply to this code. Work Value Non-Fac PE Fac PE Malpractice Non-Fac Total Fac Total 99510........................ 0.00 0.00 0.00 0.00 0.00 0.00 160 CPT © 2014 American Medical Association. All Rights Reserved. © 2014 OptumInsight, Inc.
