ACBHCS QA 4.2013 - Alameda County Behavioral Health

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Example of Counseling & Coordination of Care—Outpt. • A client returns to a psychiatrist’s office for a medication check. • The encounter takes a total of 25 minutes, during which time more than 12.5 minutes is spent explaining to the client about how a newly prescribed medication works, how to establish a routine so that no doses will be missed, and the possible sideeffects of the medication and what to do if they occur. • The appropriate E/M code would be 645‐99214 (office or outpatient service for an established client), based on the 25‐ minute time rather than on a detailed history and examination and moderately complex medical decision making that would be required to use this code if counseling and coordination had not taken up more than 50 percent of the time. • The psychiatrist documents the extent of the counseling/coordination of care in the daily progress note.
Medical Necessity—CMS • The Center for Medicare and Medicaid (CMS) defines medically necessary services as those that are • “reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member” • In short, services must be clinically appropriate for the client’s condition
Page 1 and 2: ACBHCS QA 4.2013
Page 3 and 4: AGENDA • Why we are doing this tr
Page 5 and 6: New InSyst Procedure codes map to M
Page 7 and 8: Retained Procedure Codes Old New CP
Page 9 and 10: Psychiatric Diagnostic Evaluation P
Page 11 and 12: Non E/M Codes (Psychotherapy & Cris
Page 13 and 14: Time Spent in Session: examples 1.
Page 15 and 16: PSYCHOTHERAPY FACE TO FACE TIME = 3
Page 17 and 18: Add‐On Codes (+) Add‐On (+) cod
Page 19 and 20: Crisis Code 377‐90839 (Used Alone
Page 21 and 22: Crisis Code 377‐90839 + 378‐908
Page 23 and 24: Add‐On Code for Additional Servic
Page 29 and 30: Interactive Complexity (+) 491‐ 9
Page 31 and 32: Psychotherapy Add‐on Codes to E/M
Page 33 and 34: Evaluation and Management (E/M) Cod
Page 35 and 36: CPT E/M New client Definition—CBO
Page 37 and 38: Two Paths to E/M Selection • PATH
Page 39 and 40: Path 1: Choosing the E/M Code Based
Page 47: See hand‐outs Progress Note Templ
Page 51 and 52: General Principles of Documentation
Page 57: Path 2: Choosing the E/M Code Based
Page 63 and 64: See E/M Progress Note Template Base
Page 65 and 66: Medication Support: RN/LVN/Psych Te
Page 67 and 68: Elimination of AB3632 procedure cod
Page 69 and 70: Training Resources: The National Co
Page 71: Resources continued: • AMA Code B

ACBHCS QA 4.2013 - Alameda County Behavioral Health

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