This article is intended to provide general coding guidance based on national standards. The type of code you select depends on the member's needs, your license and type of service you provided. Please note that some CPTs have minimum documentation requirements (please check the provided grid and resources for examples). It is important to select the correct CPT and accurate diagnosis in support of services provided.
We understand there may be coverage concerns around using certain codes (e.g., couples therapy CPT codes). We believe that documenting and reporting services accurately are the most important aspect of picking the most accurate code, and we can address coverage concerns as they arise.
Lastly, this document is not exhaustive of the CPT codes that you may need to use as part of the care you provide, and is meant to be an initial education primer. Please feel free to contact us at provider@joinmodernhealth.com for any questions or comments about the listed CPTs.
What is a CPT code?
CPT codes describe medical or therapeutic services or procedures performed by a provider. CPTs are developed by the American Medical Association and are the national standard for all activities related to claim submission describing services. For additional context, the CPT code explains the services provided, and the ICD code set (below) describes the diagnosis and why the treatment was necessary.
What’s a diagnosis and what’s an ICD-10 diagnosis code?
Diagnosis is the determination of which disease or condition is causing a person's signs and symptoms. Diagnostic coding offers a categorized and concise format for providers to describe their patient’s symptoms and diseases. Diagnosis codes also help support the provision of treatment, determine progress and effectiveness of treatment, and evaluate the quality of care in relation to identified symptoms and needs.
How does my documentation tie into the code I choose?
For starters, quality care is supported by quality documentation. Your documentation is a record of the service you provide that other practitioners may reference to make care decisions. Also, your notes help to substantiate the diagnosis and codes that you choose to invoice Modern Health for.
Which CPT code should I choose?
Here are examples of codes, descriptions, associated times, and documentation requirements.
| Provider Type | Session Duration | Treatment Specifications | CPT Code | Documentation Requirements |
|
License Types: LSW, FMT, LISW, LPC, LPCC, PsyD, NP/RN, MD |
Intake session (Not time driven, but typically 30-90 min) |
BioPsychosocial Assessment |
Medical/Psychiatric history; Mental status exam; initial Diagnosis; evaluation of patient’s ability and capability to respond to treatment; initial treatment plan; |
|
|
38-52 minutes |
Individual psychotherapy |
time; member response; progress or lack of progress towards set and agreed to treatment goals. |
||
|
53 minutes or more |
Individual psychotherapy |
time; member response; progress or lack of progress towards set and agreed to treatment goals. |
||
|
Only first 60 minutes billed |
Psychotherapy for patient in crisis |
Documentation Requirements: time; member response; progress or lack of progress towards set and agreed to treatment goals. |
||
|
Additional 30 mins |
Add on -Psychotherapy for patient in crisis |
Documentation Requirements: time; member response; progress or lack of progress towards set and agreed to treatment goals. |
||
|
26 minutes or more |
Couples/family psychotherapy |
Time and Addressing needs identified |
What ICD-10 diagnosis code should I choose?
Choose the ICD-10 code that is most accurate in reflecting signs and symptoms exhibited by the member. You can have more than one diagnosis. However, only one serves as the primary (first) diagnosis.
Can I bill two visits in one day for the same member?
Insurance companies will not pay for two visits in one day for the same member. While we can support this with our normal visits, HPI visits can not support two visits for the same member in one day.
Are there other resources I can explore?
- ICD 10: https://www.icd10data.com/
- CPT: https://www.aapc.com/codes/cpt-codes-range/
- If a code you’re looking for is not available on the Modern Health provider dashboard, please reach out to provider@joinmodernhealth.com and we can assist you
Definitions
- ICD-10: ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. (ICD-11 was released on 1/1/2022, however, we will continue using ICD-10)
- CPT: The Current Procedural Terminology (CPT®) codes offer doctors and health care professionals a uniform language for coding medical services and procedures to streamline reporting, increase accuracy and efficiency.
CPT codes are also used for administrative management purposes such as claims processing and developing guidelines for medical care review.