Transcript Document

Office of the Governor | Mississippi Division of Medicaid
Therapeutic and Evaluative (T&E)
Mental Health Services
for Children
Provider Training
October 30, 2014
Policy/Administrative Code
• Current Policy Section 21 T&E Mental Health
Services for Children has not been updated
since 2009 aside from reformatting.
• Administrative Code Proposed Effective Date of
July 1, 2015.
• Once the code has been approved a Late
Breaking News article will be posted on the
Xerox web site and also placed in the Provider
Bulletin.
OFFICE OF THE GOVERNOR
|
MISSISSIPPI DIVISION OF MEDICAID
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What Will Stay the Same
• Population – T&E services are for children
under the age of 21.
• Covered Services – There will be no change
in coverage for these services.
What Will Stay the Same
• Providers – Regardless of the type of T&E provider
(individual provider or a group practice) currently
o Licensed Professional Counselors (LPCs) cannot
provide T&E services.
o Psychometrists are not allowed to conduct the testing
for evaluations or complete psychological evaluations.
o Licensed Clinical Social Workers (LCSWs) cannot
provide services to adults.
o Psychological Evaluations must be completed by a
licensed psychologist & should include any
recommendations for placement or therapy services,
etc.
What Will Change
• Name of the service is currently Bio-psychosocial Assessment will be changed to
Psychiatric Diagnostic Evaluation.
• The corresponding HCPCS code (H0031) to
CPT Code (90791).
• The rate will be updated to reflect the
change from a HCPCS to a CPT code.
• Definitions will be expounded to include the
clinical purpose.
What Will Change
• Documentation Requirements
oThe Date of service with the day, month, and
year.
oInstead of just the name, title, and signature; it
will be necessary to include the credentials of the
person who provided the service AND the person
who documented the service, if two different
people.
oDocumentation should be legible so it can easily
be read by reviewers.
Proper Billing Guidelines
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Place of Service (POS)
National Correct Coding Initiative (NCCI)
Group Therapy
Modifiers
Billing on One Claim Form
Place of Service (POS)
• Please use the appropriate POS on your
claims.
o 3- School
o11- Office
o12-Home
o14-Group Home
o99- Other
• Note: POS 53 is not an appropriate POS.
NCCI Edits
• The CMS National Correct Coding Initiative (NCCI)
promotes national correct coding methodologies and
reduces improper coding which may result in
inappropriate payments of Medicare Part B and
Medicaid claims.
• Please note the Medicaid NCCI program is different
than the Medicare NCCI program.
• NCCI Edit files are updated quarterly.
• Medicaid NCCI Edit files and reference documents can be
found at this link: http://www.medicaid.gov/MedicaidCHIP-Program-Information/By-Topics/Data-andSystems/National-Correct-Coding-Initiative.html
NCCI Edits
• Procedure codes for mental health services
fall under the Procedure To Procedure
(PTP) edits for practitioner and ambulatory
surgical center services.
NCCI Edit
• “How to Use the Medicare National Correct Coding
Initiative (NCCI) Tools” at
http://www.cms.gov/Outreach-andEducation/Medicare-Learning-NetworkMLN/MLNProducts/Downloads/How-To-UseNCCI-Tools.pdf provides useful information on
pages 4 - 6 about the column 1/column 2 code
pairs. Pages 13 -14 provide useful information on
how to filter the edits.
Modifiers for NCCI Edits
• Modifier Indicator Table
Modifier Indicator
Definition
0 (Not Allowed)
There are no modifiers associated with NCCI that
are allowed to be used with this code pair; there are
no circumstances in which both procedures of the
code pair should be paid for the same beneficiary on
the same day by the same provider.
1 (Allowed)
The modifiers associated with NCCI are allowed
with this code pair when appropriate.
9 (Not Applicable)
This indicator means that an NCCI edit does not
apply to this code pair. The edit for this code pair
was deleted retroactively.
NCCI Edit Modifier Indicator
Example
NCCI and Group Therapy
• Only one Group Therapy (90853) is allowed to be
billed per date of service according to the
information available in Section V on page 40 at
this link: http://www.medicaid.gov/Medicaid-CHIPProgram-Information/By-Topics/Data-andSystems/National-Correct-Coding-Initiative.html.
Modifiers for T&E Services
• HA modifier should be placed on all T&E
claims in the 1st modifier position.
• For an NCCI Edit the most appropriate
modifier should be placed in the 2nd
modifier position, which can be found on
the NCCI Edit page. You may also find the
most appropriate modifier by referencing
the most current CPT Code Book.
Billing on One Claim
• Services provided to the same beneficiary
on the same date of service should be billed
on one claim form.
Contacts
• Kimberly Evans – Mental Health Services
[email protected]
• Charlene Toten – Mental Health Services
[email protected]
• Kimberly Sartin – Mental Health Services
[email protected]
• Bonlitha Windham – Office Director
[email protected]
(601) 359-9545
OFFICE OF THE GOVERNOR
|
MISSISSIPPI DIVISION OF MEDICAID
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