Coding Consult

July 8, 2005


Still, some insurers' policies on paying for mental-health services are tricky. To avoid having your claims denied, you have to code correctly. Here's what you need to know.

How to code the initial visit Consider these two scenarios:

Some doctors recommend focusing on signs and symptoms in place of depression codes to prevent carriers' denials. But George Ward, billing supervisor with South of Market Health Center in San Francisco, doesn't agree. "If you've made a diagnosis of depression, then you should code for that," he says. However, if you can't reach a definitive diagnosis of the depressive state, then it's okay to rely on signs-and-symptoms coding, says Mary Falbo, president of Millennium Healthcare Consulting in Landsdale, PA. For example, if the patient has fatigue (780.7x, malaise and fatigue) and a lack of sleep (307.41, transient disorder of initiating or maintaining sleep), use those diagnoses as the medical justification for the E&M visit.

Should you ever use diagnosis code 311 (depressive disorder, not elsewhere classified)? That's reserved for a truly depressive, psychiatric diagnosis, unlike the depressive state due to a situation such as loss of job, divorce, and so on.

Report the appropriate established patient E&M code (99211-99215) based on the total time you spent with the patient, assuming that counseling and coordinating care was the predominate portion of the visit. Be sure to document that the counseling took more than 50 percent of the physician's face-to-face time with the patient, says Falbo. In this case, 10 out of the 15 minutes were spent counseling, so you assign 99213, which has a 15 minute time parameter, and link the diagnosis codes to it.

Another option is to code based on the elements of the evaluation and management service rather than on time. Says Ward, "We almost never use E&M codes based on time. Rather, the doctors focus on meeting the three key components-history, exam, and medical decision-making-required for new patient codes 99201 to 99205 and two components for the established patient codes 99211 to 99215."

#2 You see a patient for a follow-up visit to discuss his depression treatment plan. You change the medications and provide counseling. Based on the visit's medical documentation, you report 99213, linking the diagnosis 300.4 to the E&M code. Don't use code 90862 (pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy). Medication management is one of the medical decision-making components of the E&M service.

You've reported previous follow-up treatments with the same patient using 300.4 and the appropriate E&M code without a problem. But this time the insurer denies the claim.