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Billing and coding

  • Writer: Dr. Monica J. Jones
    Dr. Monica J. Jones
  • Jun 18, 2023
  • 2 min read

Updated: Jun 12

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

  • 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)


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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