In 1991, I jumped off into private practice and eagerly signed up to join as many managed care panels as I could. (I’m not recommending the “jumping off” or joining all those panels. But, if you’ve been following this blog for a while, you already know that.)
One of the most confounding things that I was confronted with were CPT codes. No one in graduate school talked about “CPT codes.” No one in any of the agencies I had worked in ever talked to me about those mysterious codes. And, no one in the for profit psych hospital I had just left ever mentioned those codes to me . . . .
Yet, I still thought I was just supposed to magically know about them so I tried to fake it and “act as if” I knew what they were. But, I didn’t have a clue. Perhaps you’ve been in a similar situation?
Of course, this was pre-internet days so I couldn’t hop online and ask Google “What is a CPT code? And, by the way, how do I use them?”
Eventually, I found a therapist in the community who recognized that I was clueless and kindly shared a list of the 5 or 6 codes that she used most often. It would be another handful of years before I realized that these codes were actually regulated and had very specific definitions that dictated when and and under what circumstances to use them. (That was after I had run across and purchased a CPT code handbook for Psychiatrists!) And, yes, I had been coding a few things wrong.
Fast forward two decades and I’m blogging away and keeping an eye out for a billing specialist who was interested in sharing some insights and advice with you guys. And, . . . voila! Denny Chapin reached out to introduce himself and offered to share his insights on the use of CPT codes to help us out. So, here’s a guest post by billing specialist Denny Chapin to clue you in!
(If you are interested in writing a guest post, check out the guidelines here.)
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[This guest post was removed by Tamara Suttle on 10-24-14 after guest blogger Denny Chapin declined to comply with my request for full transparency. Any reader needing additional information about current CPT coding can find that information on a Free Webcast on 2013 Changes in CPT Codes. You will find the information on this webcast to be accurate as of 01-14-17.]
Wow…great information! I sure wish I had had the internet and this information 20+ years ago! Thank you… I’m going to review this and spruce up my coding practice…
Tamara,
I think you were reading my mind as you typed this post! I have been googling, asking, and googling again – and – the information you provided is the best that I’ve gotten.
Thank you!
Kate
Kate, I’m so glad you found this information useful!
Hope it helps you increase your revenues / claim and make life easier!
-Denny
Excellent, Kate! I hope you will tell everyone you know! (At least, that’s the plan!)
Hey, Kate – You can put up your own little picture by your comments by following this little tutorial telling you how to add a gravatar. Don’t be shy!
Thanks for the cheat sheet!! Great post. Thanks, Denny!
Per usual…relevant information. 🙂
Thanks Denny and Tamara!
Hi, Jenny! I’m always tickled to get your note of approval! Thanks for dropping in!
This is a great post. For many years I had a billing service. Last year with all of the movement toward electronic records I began doing research on using it so I could enter my own client info (I had to provide it all to my biller which was sometimes awkward and time consuming). I did some research on good places for electronic records. I use Valant which is based in Washington State (I am in Texas). Their specialty is psychotherapy, so they provide extensive training, coding; transmission to clearinghouses, and forms for recording sessions Their customer service is immediate and superb. My clearinghouse is Navicure. They too have excellent service, immediate help and training. The transition was a major task, mostly inputting my customer base. The upkeep is a piece of cake. The cost is less that 1/4th of what I was paying my billing service and I was having to do all the same tasks with a biller.
Hi, Mary! Welcome back! And, thanks for adding to the resources that are already here. It’s always helpful to get endorsements for products and services from you guys!
This is a great way to find an intermediate solution between a billing service like TheraThink and pounding your head on a desk in frustration! I welcome folks to find alternative methods to get their billing done and I’m glad you found one that suits. The biggest take away I’ve found from my conversations with folks like you, Mary, is that people just need more education! It should be very cheap if not free to file claims and get paid for your services! In some sense, I really wish TheraThink and other co’s didn’t have to exist!
Glad you’re sorted and happy billing 🙂
-Denny
Hey, Denny, thanks so much for doing your part to educate and support mental health professionals and their billing! (While I’ve been traveling this week, my website was hacked and I got locked out for a few days. You’ve been great about staying engaged with this conversation and I so appreciate it.)
Thank you Tamara and Denny for this thorough and very helpful explanation of CPT codes. They have seemed daunting to me at time so it’s helpful to understand them more and how I can use them best. I will bookmark this page for later reference. Thanks for always providing just what it seems I am needing at the time!!
Hi, Kate! Welcome back to Private Practice from the Inside Out!
I know exactly what you mean by “daunting!” Once I learned that there are very specific definitions for these numbers and unique circumstances under which they were to be used, I finally understood (like Denny said) that CPT codes weren’t nearly as complicated to use as I had initially thought.
So glad you continue to find the information here useful to you and hope you’ll spread the word to others, too. The table is large here and the more voices we have joining us, the stronger and healthier our online community will be!
Great information. I can focus more on clients and less on billing.
Hi, Brenda! I know that working with clients is your passion so I’m happy to help you focus more on them! Have a great day!
Tamara and Denny –
Indeed, even for someone who is an out of network provider, I need to know that I am composing my superbills correctly so that my clients can get reimbursement.
I’ve actually never used an add-on code given that I am an out of network provider. I guess I feel like part of what I offer given that I’m out of network is a little bit of extra attention. Thoughts on this?
Take care,
Amy
Hey, Amy, thanks for pointing out that even therapists who do not work directly with insurance companies need to know how to accurately assign CPT codes. It can mean the difference between a client getting partially reimbursed for our services or not.
I’m not sure what you mean when you say ” . . . Part of what I over . . . is a little bit of extra attention.” Are you saying that you want to count that “extra attention” as an add-on? Please explain.
Hi, Tamara & Denny! Love this post– very timely. I had actually written Tamara a few weeks back about a client’s request for me to “down code” (didn’t realize there was a term for it) from 90837 to 90834 so that they could receive reimbursement for services rendered.
At the time, I had asked around to see if this was ethical & legal. My concern was: wouldn’t coding a service by a different CPT code than the service offered constitute fraud, even if it was documenting a shorter amount of service? The insurance company had told me to do it, but I felt uncomfortable billing for a different service than the one provided & documented.
Denny, do you have any thoughts or recommendations about the practice of down coding? What is the standard in the profession? I would love to hear your thoughts. Thank you!
Hi, Ann! Thanks for dropping in this evening and bringing this back to Private Practice from the Inside Out! It’s a choice that many therapists are faced with and I don’t know the real answer here so I’m hoping Denny does!
Ann, great question. This is a tough one — it is illegal (and will void your contract with insurance cos) to misrepresent services provided in order to receive reimbursement. As a result I cannot recommend such a practice to any of my clients although I will say it is common.
An easy way to nip this problem in the bud is to pre-verify ALL new patients and reference a diversity of your most common CPT codes to ensure a new patient is eligible (and for how many sessions). Ask about CPT 90847 vs 90834 and always make sure to get a call reference ID to keep the insurance company accountable — if they tell you you can bill for 90847 and then later fight you on it, reference the call.
If you see a patient for family therapy but choose to bill individually, there is little an insurance company can do to verify the difference (besides Orwellian cameras in every room! 😉 But I encourage you and others to do the due diligence to make sure before hand so you render services you know will be paid in full.
This is my #1 tip for therapists: always check eligibility of benefits on the phone! Or sign up for a service like TheraThink and we’ll do it for you 🙂
Hope this helps!
-Denny
Denny, thanks so much for addressing that the practice of misrepresenting your services – whether upcoding, downcoding, or intentionally providing inaccurate information – is illegal and unethical. And, your suggestions that pre-authorization of insurance benefits should include an inquiry about which CPT codes get covered and tracking reference IDs are spot on. Here’s a blog post I wrote a while back on How to Verify Insurance Benefits for Your Services.
Denny, Thanks for shedding some light on this. When the CPT codes change in 2013, I did a lot of research and even went to some webinars to help understand the changes. Your resources are very helpful and you really seem to have demystified things a bit more.
Hi, Lauren! Thanks for dropping in tonight!
Glad we could help!
-d
Tamara, thanks for a great resource as always! CPT codes were one of the most confusing things for me when I switched to private practice … honestly I still find them a bit overwhelming if I think about it too hard.
I also really appreciate all the information that is coming in through the comments – thanks everyone!
Yep! I can totally relate! Like I said, I made more than my share of errors when I started using them. It seems like such a critical piece of information for those of us in private practice, that I would think that managed care companies – as part of their “welcome” package – would just send out a brief explanation of them!
Tamara,
What a great website you have put together. Good work. Per your request, I including a link for the free handout on all DSM-5 diagnosis codes (with their ICD 10 updates required after October 15th 2015). It is a simple, printable version in a compact size. I hope it is useful for lots of people!!
http://www.justinkhughes.com/professionals.html
-Justin Hughes, MA, LPC
Hey! Justin! That’s so generous of you to share this extensive list of CPT codes and I noticed it actually links to training that you’ve provided, too! Thanks for sharing!
I also notice that you are in my old stomping grounds – Dallas and Denton, Texas. Oh, I’m getting homesick for that good Texas cooking even thinking about it 🙂 I got my Master’s degree at University of North Texas – Denton and lived in Southlake (so I played equally in Dallas and Tarrant Counties). It’s always good to connect with therapists back home!
I’m glad you like what you see here and I hope you won’t be a stranger and will drop in often to join the conversations here. I think you will find the online community here at Private Practice from the Inside Out to be lively, open, and welcoming to all mental health professionals – and certainly to one who has shared such a useful tool with us. Thanks again!
That’s great, Tamara! You are in a beautiful area; I spent a semester in CO Springs. Always let me know if I can be helpful in any way!
Justin
Thanks, Justin! Happy to know of an addictions professional in DFW and happy to network with you, too!
I just found your website today, Tamara. What a boon! Having just moved to Michigan last year from Los Angeles where I completed my MFT grad schooling and traineeship, I had to figure out all the byways of getting reciprocity for both my licensing in marriage and family therapy and certification in Alcohol and Drug Counseling (in CA, I am “MFTI” and “CADCA”). I am awaiting my AOD counseling reciprocity but have been a limited license marriage and family therapist (LLMFT; comparable to MFTI in CA). Unfortunately, Michigan is LMSW and LPC friendly but no so much LMFT.
I am starting my own private practice since I am having no luck finding work here due to my licensing. This seems like a silly question but I had an interview recently with a center that asked me if they could bill managed care with my license. How can I find this information out? I have called and emailed all manner of persons and places including my licensing board to no avail.
My plan is to work a private practice on weekends and a couple evenings while having employment at a facility.
Also, have you had any blogs about whether to advertise services in publications, local newsletters, and if that is worthwhile.
And finally, any blogs about how to develop and market for group therapy since that is my forte and I would love to offer group therapy as part of my private practice.
Thank you for your help. Great website. I need to build one as well in the near future. I already have my logo I would like to have designed.
Oh, Maria! So glad you found me just in time! Welcome to Private Practice from the Inside Out and welcome to your big new adventure! I relocated from Texas to Colorado in 2014 and can really empathize with your challenges and concerns. Let’s see if I can chip away at some of these . . . .
I don’t understand what your interviewer (in California?) was asking – can they bill managed care with your license in Michigan? Or once you are licensed in California? Either way, the question scares me. How is it an agency that does billing doesn’t know what managed care companies allow? That’s . . . Disconcerting to say the least.
As for your question, the way you find out is always going to be to contact the Provider Relations Department of the individual insurance / managed care company and ask them if they will cover your particular services with your particular credential. (I’m encouraging you to make this inquiry in writing because you want their response in writing and you want to keep it as “proof” in case you need it down the road.) It is the individual managed care companies that decide what services they will cover and who they will reimburse for coverage – not a licensing board.
Here are some blog posts that address advertising
– Are Online Directories Worth Your Time and Money?
– 4 Things You Must Know before You Decide to Advertise
– 9 Ways Blogs (and Newsletters) Can Help You Grow Your Business.
I don’t have blog posts up that specifically talk about marketing groups vs. Family or Individual therapy. The principles would be the same, though. Get seen, get known, get trusted, ask for the business. Maria, I’ll give this some thought, though and put this on my to-do list for future blog posts. Thanks for the idea!
Denny, thanks so much for your guest post here and for sharing it with your peeps!