New Procedure Codes for Mental Health Services

The American Academy of Professional Coders is a worldwide organization that provides medical coding certification, education, networking, and recognition for medical coding professionals. Medical coders review medical documentation in patient files, identify and code the completed treatments and procedures, and prepare billing for patients and insurance companies. Proper coding is required to identify procedures and services; it must meet insurance and federal regulation requirements, and improper coding may affect reimbursement from insurance, Medicaid and Medicare. Mental health professionals depend on professional coders to produce accurate documentation and billing for payment and reporting purposes.

Types

• There are several major healthcare coding systems developed by the American Medical Association and the World Health Organization: CPT, HCPCS, ICD-9, and ICD-10. The AMA writes, copyrights, and annually updates CPT codes and HCPCS codes. CPT codes, for Current Procedure Terminology, are numeric codes for procedures done on an outpatient basis and/or in a physician's office. HCPCS codes, for Healthcare Common Procedure Coding System, are alphanumeric codes for supplies, products and services that don't fall under CPT coding, such as a walking cast or ambulance service. For Medicare and Medicaid billing purposes, CPT codes are level one and HCPCS codes are level two.

  The WHO creates and updates ICD codes for diagnosis, procedures and inpatient hospital services as an international classification system. Its purposes extend beyond mere billing into classifying and monitoring health and disease in groups and populations worldwide. ICD-9 codes are used in the U.S. but are considered ineffective and obsolete by The American Health Information Management Association. Most other countries are using the ICD-10 codes. The Centers for Medicare & Medicaid Services issued a final rule in January 2009 that determined October 2013 to be the start date for the U.S. adoption of ICD-10.

Updates

• CPT codes are updated annually by the AMA in their manual Physician's Current Procedural Terminology, with changes and additions arriving up to four times during the year. You can order this manual by calling 1-800-621-8335; it's offered in hard copy or electronic versions.

  WHO reviews and revises ICD codes periodically. Their official guidelines are published by the CDC and are available at www.cdc.gov/nchs. There are numerous newsletters and subscription services, as well as courses and workshops, to keep professionals current on the annual changes and any changes made during the year, and professional associations keep their members advised of the newest code revisions. Organizations such as the American Nurses Association, the American Psychiatric Nurses Association, the American Psychological Association and the National Association of Social Workers all have coding resources to assist members.

Oversight

• Several governing bodies---and some government regulations---are involved in the development and use of medical classification and coding systems. Watchdogs include the World Health Organization, the American Health Information Management Association, the American Medical Association and the Centers for Disease Control. The Health Insurance Portability and Accountability Act is an important piece of legislation on the matter.

Benefits

• Incorrect coding causes payment delays, so the most accurate coding professionals will be true assets to their organizations. Using codes that have been discontinued or changed will result in returned billing and rework of documentation. The most current and updated codes more accurately reflect the newest medical procedures and technologies, and knowing and understanding these reflects professionalism, accuracy and expertise.

Expert Insight

• There is a lot of support available for professional coders who must keep current with codes and systems. With a multitude of training, educational and reference resources available, both through traditional and newer electronic routes, the complex, evolving work of medical billing coding is more accessible than ever.