Billing Codes
What code should you bill if less than 3 group or day treatment clients show up?
Bill group or day treatment code.
As long as 3 people are enrolled, you can still bill these codes if only 2 show up.
Which document do you complete to state you agree with a diagnosis from an outside DA and add any missing information to the DA?
A DA Addendum
Which two therapy codes can be billed on the same day as psychoeducation?
Diagnostic assessment and psychotherapy
Which document must be completed BEFORE an ARMHS ITP?
The functional assessment.
How old can a client be to bill Clinical Care Consultation?
Up to 20 years old.
Note: This is not a CTSS code. It is an outpatient code so any therapy client 20 or younger is eligible if it is medically necessary.
How many staff must bill group for CTSS groups of 9 kids?
At least 2 staff.
Note: 3-8 kids- at least1 staff; 9-12 kids- at least 2 staff. Cannot have more the 12 clients in a group.
These rules are the same for therapy groups
ARMHS groups- 2 staff can bill group for 2-10 clients. Cannot have more than 10 enrolled in a group.
What steps do you take when determining whether or not to use an existing DA (for an addendum or when reopening a client regardless of how old the DA is)?
1. Meet with the client/caregiver(s) to determine if the DA is still up to date and relevant.
2. Use clinical judgement to determine if you concur with the old diagnosis.
Which two documents can be used to establish medical necessity for Psychoeducation?
The DA or the ITP.
Psychoeducation can be added to the ITP even if it isn't on the DA.
Who is included in the treatment team for both children and adults?
The treatment team can include (but is not limited to) the client, guardians/support people, MHP, therapist, case manager, and/or med provider.
Who can you bill CCC with? (Name at least 3)
Important Note: A therapist CANNOT bill CCC for talking to an MHP who also works at Fernbrook. If they work at a different agency, this is allowed.
When can you bill two therapy codes or therapy and skills codes back to back?
When you are providing two distinct services and the client is aware you are providing two different services.
How do you make a correction to a DA you recently completed? Examples include: fixing the F code, clarifying information from the client after the explanation of findings, redacting information prior to release.
Complete a DA amendment.
What are the requirements for the progress note for psychoeducation?
(Get 3 our of 6 for full points)
-Type of services (individual, family, peer group, family group)
-Interventions used
-Number of attendees
-Roles of attendees
-Attendees responses to interventions
-Potential impact on client
Which code can only be used for treatment planning with children IF a treatment plan is eventually completed? It must be taken back if an ITP is never completed for that client.
H0032 treatment plan review and development
True of False: The CCC code you use is determined by how long the consult was and what modality you used (telephone or face to face).
True
What code would you bill when providing skills or therapy to a caregiver only?
Family skills/ Family psychotherapy without client present.
This code is NOT billed when casually chatting with a caregiver or giving an update on what you did at the end of a session.
When are we required by statute to update a DA? (get 3 our of 5 for full points)
-There are significant changes that impacts the course of treatment (i.e. you are adding new service recommendations because the impact on functioning has changed.)
-There is a change in diagnosis.
-The client requests one.
-The client had a brief DA and needs additional services (more than 10 therapy sessions).
-The client has TCM and it has been 3 years since the last DA update.
What is the difference between psychoeducation and psychotherapy?
Psychoeducation is educating clients and caregivers about aspects of mental illness, treatment, and recovery. Psychotherapy is using therapeutic interventions to directly treat symptoms of mental illness.
What are the only CTSS statute requirements for ITP goals and objectives? (get 2 out of 3 for full points)
They must be measureable
They must have a baseline
They must have a target success rate
Note: There are no statutes that mandate HOW we can measure goals and objectives (i.e. by report or in session).
When can two Fernbrook therapists bill CCC for consulting with one another?
If they work with the SAME client to provide a therapy service (i.e. day treatment and individual or individual and family, etc.).
You cannot bill for consulting when two therapists work with two different siblings or clients who are otherwise related.
Note: They have to split the consultation time. They cannot both bill for the whole time.
Before "stacking" codes, which three questions should you ask yourself?
("stacking" codes is billing more than one code for the same client in a day).
Did I provide two separate services?
Am I only billing these codes because it benefits me to do it this way?
Does the client benefit from theses two separate services?
True or False: If a service is recommended on the DA, you can adjust the number of recommended hours on the ITP without updating the DA.
For example: Therapy is recommended for 4 hours per month on the DA. Client now needs 6 hours per month of therapy.
True.
True or False: Psychoeducation can be billed for general parent education.
False.
Psychoeducation cannot be billed for parent education. It can only be billed for education related to the mental health diagnosis.
What code would a therapist bill for initial treatment planning with an adult or child who is a NEW client between the time of DA completion and the time of the initial ITP being completed?
Psychotherapy
Use the appropriate psychotherapy code (not the pre-DA codes).
True or False: CCC can be added to the ITP even if it is not recommended in the DA.
True. Medical Necessity for CCC can be determined in the ITP if it isn't recommended in the DA.