Wiki IBH Preventative Counselling vs Psychotherapy

Hi there! I work for an FQHC that provides Integrated Behavioral Health services, and the guidance they had received in the past said to bill 90832-90838 psychotherapy codes for F dx code conditions, and 99401-99404 preventative counselling for R dx codes where the sign/symptom hadn't yet become a full condition, hence the preventative counselling to hopefully stop it from becoming one. However, within the last year, we've gotten pushback from payors saying that the LCSWs and MSWs shouldn't be billing the 99401-99404 codes at all and are asking for just the BH codes instead (and are also trying to send the IBH claims to BH plans instead of the main medical plan, but that's a separate issue). Should we be billing all the LCSW and MSW visits with the psychotherapy codes? Is there another sort of preventative counselling code we should be billing for the IBH claims? Or should we keep billing the E/M preventative counselling codes and push back on this issue with the payors?

e1graul
LCSW and LPC can bill beh health 90832-90857 and assessment 96156 -96168 CPT codes. Ensure they list minutes on documentation and describe pt s problem and suggestions along with beh health dx codes F01-F98 and R45 dx blocks. The MD DO PA NP can bill just about any CPT as long as documented and they credentialed per payer. Preventive health codes 99401-99409 usual refer to smoking, dieting, alcohol, sex disease abuse but you cannot bill these same times as other beh. health CPT codes of 90832-90847 . Definitive dx codes better than R symptoms code but you can see by checking CMS Phys website of CPT codes linked with which dx codes. Also MD DO NP PA can bill Eval mgnt XCPT codes 99202-99214 for medical or chronic or current illness problems ( as example DM, HTN , HLD, G47, etc ) but if pt suffering with sub abuse problems can counsel pt. add modifier 25 then link that sub abuse problem to CPT 99401-99409 during same day treatment. I hope helped you somewhat
Lady T