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RaySmith
Dec 06, 2016

I Gotta Code and Fervor

“I gotta code and fervor,” no, it’s not a typographical error, even though this is the flu season when we hear a lot, “I’ve got a cold and fever!”

A counselor in private practice has to learn how to provide billing codes to insurance companies in order to take care of their insured. There are many different codes used for mental health, as well as thousands for all of the other medical specialties which we (happily) don't have to learn. Most of the codes that we use, we can use all of the time and eventually memorize. For example, the code for a diagnostic initial intake interview examination is 90791, and the code for a routine session for an established client is 90834. These are CPT codes that are contained in books that are republished each year with all of the changes.

While that might sound simple enough, there are also codes to modify a session, for example, if there is a prolonged evaluation and management service given during the appointment, there is another special code for that. Counselors would have to have a special passion or fervor in order to learn all of the different codes and their modifiers.

In addition, we have to learn the diagnostic codes in order for insurance companies to find our charges medically necessary and on their approved list. There are several codes for problems that people have that do not qualify as medically necessary in the eyes of the companies that are every month taking their premiums with the assumption that they will pay benefits in the time of need. For example, since October, the ICD-10 code for major depressive disorder, single episode, unspecified, is F32.9.

If your graduate education was something like mine, then these codes were never mentioned, nor getting credentialed to be on an insurance panel to use them.

If you are ready to start your private practice, then you might need some coaching and help to get your head around all of the different codes that you will need for a successful private practice. If I can help, then please give me a call at 509.466.6632.  
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Dr. Ray Smith integrates theology and psychology as an ordained Presbyterian minister as well as a licensed mental health counselor and an adjunct professor of counselors in Spokane, Washington.
               

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2 Comments

  1. 2 Julie 05 Apr
    Hello Dr. Smith,
    What books or other educational tools do you recommend for reference in billing for my private (counseling) practice in North Carolina? I am currently looking for help with coding for a superbill in particular. 
    Julie
  2. 1 Michele Hansen 06 Jun
    I would love to know if there is a CPT coding list or booklet that I may purchase for my self-pay private practice. I want to make sure I am billing fairly and accurately for my clients.
    Is there a website for these codes that I may purchase or download?

    Thanks,
    Michele Hansen, LPC
    16-250-7302

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