Medicare Documentation Training

1. MedicareDocumentation Training Santa Barbara County ADMHS 2008-09

2. Who can bill Medicare Part B? • Physicians • Physician Assistants & Nurse Practitioners • Licensed Psychologists • Licensed Clinical Social Workers • Only fully licensed professionals can bill Medicare – not interns, trainees, psychological assistants, registered psychologists, or post-docs.

3. Limitations • Service must be in the office. • Must be face-to-face with the client. • Must be part of the service plan.

4. Documentation Requirements Eachoutpatient note must include: • Symptoms or complaints • Progress to date in objective, observable terms • Functional status • Assessment, clinical impression, or diagnosis • Plan for future care • Prognosis

5. Why? • State and Federal laws require that all Medicare-billable services be billed to Medicare, notdirectly to Medi-Cal.

6. Gateway and Medicare:Psychiatric Outpatient Services • “MD Visit – Complex” = CPT 90862 • “MD Visit – Brief” = HCPCS M0064

7. MD Visit – ComplexCPT 90862 • Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy. • In-depth management of potent psychiatric medications with the potential for serious side effects. • Not a brief evaluation of the patient’s status or adjusting the dosage of long term meds.

8. Med Visit – Brief HCPCSM0064 • Brief office visit for the sole purpose of monitoring or changing drug prescriptions used in the treatment of mental, psychoneurotic and personality disorders.

9. “Assessment” Converts to CPT 90801 for Medicare Documentation in the notemust include: • history • complete mental status exam • diagnosis

10. Assessment For Medicare beneficiaries – May only be billed once unless there is a: • new episodeof mental illness after a hiatus or • psychiatric hospitalization

11. Psychotherapy Documentation of each service must include: • Specific symptoms or complaints • Progress to date in objective, observable terms • Functional status • Assessment, clinical impression, ordiagnosis • Plan for future care • Prognosis

12. Psychotherapy • Like Medi-Cal, a specific therapeutic intervention must be documented. • Depending on time billed, automatically converts to CPT 90804, 90806, or 90808 for Medicare beneficiaries. • Only face-to-face time is billable to Medicare – not documentation time.

13. INPATIENTCPTCODES (PHF)

14. CPT E/M CODESInitial Hospital CareBasic: 99221Moderate: 99222Complex: 99223Subsequent CareBasic: 99321Moderate: 99322Complex: 99323

15. Level 1 – Basic • Obvious diagnosis (or limited possibilities) • Focus on psychiatric system only • Basic psychosocial history (since last seen) • Low morbidity / mortality • (Treatment is generally progressing as expected) • Level 2 – Moderate • Moderately complex diagnostic process • Other body systems involved • Moderately complex psychosocial history • Moderate morbidity / mortality • (Substantial changes in symptoms, significant side effects, not responding to treatment as expected)

16. PHF DISCHARGE CODES Discharge Day Services, 15-30 minutes CPT 99238 Discharge Day Services, >30 minutes CPT 99239 Aftercare instructions, discharge medications, coordination of aftercare

17. Thank you for coming today. Please fill out the evaluation form before you leave. Questions? QA Office 681-5113 jsleigh@co.santa-barbara.ca.us newilson@co.santa-barbara.ca.us