Billing and coding
- Dr. Monica J. Jones
- Jun 18, 2023
- 2 min read
Updated: 1 day ago
Reimbursable ICD-10 codes that can be used as referring provider diagnoses and as treatment diagnoses:
R41.844 Frontal lobe and executive function deficit: Cognitive deficit in executive function
R41.840 Attention and concentration deficit: Cognitive deficit in attention or concentration
R41.82 Altered mental status, unspecified
R44.9 Unspecified sensations and perceptions
R53.83 Other fatigue
F89 Unspecified disorders of psychological development
Current Procedural Terminology (CPT®) that can be used to bill for treatment and evaluations:
97129 Therapeutic interventions that focus on cognitive function (e.g., attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (e.g., managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes
97130 Each additional 15 minutes (List separately in addition to code for primary procedure.)
97110 Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion, and flexibility
97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes (most used for billing with children and adolescents)
97535 Self-care/home management training. Includes Activities of Daily Living (ADLs), compensatory training to improve functional limitations, safety procedures, and adaptive equipment training (most used for billing with teens and adults)
Evaluation codes (most used):
97166 Moderate Complexity
97167 High Complexity
97168 Reevaluation
The Moderate and High Complexity evaluation codes most clearly represent the level of clinical decision-making I am doing in the outpatient mental health setting. I bill the reevaluation code usually at the 12th visit/3 month mark, although sometimes sooner and sometimes later. The reevaluation code is appropriate to bill if you are readministering formal evaluations, such as the COPM and the FOSQ-10, you suspect a significant change in the client's functioning, and the reevaluation would yield a change to the plan or care, such as continuing or discontinuing services.
References:
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