Behavioral Providers Specialty Training
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1 EPF-Behavioral Specialty Training Presentation Behavioral Providers Specialty Training Welcome Providers! January 31, 2013
2 Vianey Licon Provider Relations Representative ext
3 Sonia Lopez-Claims Director Janel Lujan-Health Services Director
4 Sonia Lopez Claims Director ICD-10 Overview
5 Implementation Date
6 ICD-10 Code Count Comparison
7 Day Submission Illustration
8 Inpatient Professional Service DOS After 10/1/2014
9 Inpatient Facility Services Discharge after 10/1/2014
10 Inpatient Facility Services Discharge before 10/1/2014
11 1. Major Goals for ICD-10
12 Diagnosis Comparison Chart
13 Procedure Comparison Chart
14 Structural Distinction of the Diagnosis Codes
15 ICD-10-CM Helpful Links
16 Psychiatry and Psychotherapy Coding Changes in 2013
17 Significant Changes to 2013 Psychiatry CPT Code Set Effective January 1, 2013 Current Procedural Terminology (CPT). El Paso First Grace Period through January 31, 2013
18 Deleted CPT Codes psychiatric diagnostic evaluation interactive psychiatric diagnostic evaluation thru outpatient psychotherapy thru interactive psychotherapy interactive group therapy Effective January 1, 2013
19 New CPT Codes Psychiatric Diagnostic Evaluation (no medical services) Psychiatric Diagnostic Evaluation (with medical services) thru Psychotherapy Group Psychotherapy Interactive Complexity (Informational) Effective January 1, 2013
20 Psychotherapy Service Only Primary Codes Psychotherapy 30 min Psychotherapy 45 min Psychotherapy 60 min Interactive Complexity ADD ON CODES [ Billed with E & M Code ] Psychotherapy 30 min Psychotherapy 45 min Psychotherapy 60 min Psychotherapy 60 min.
21 Evaluation & Management Codes
22 Evaluation & Management Codes ADD ON CODES [ Billed with E & M Code ] Psychotherapy 30 min Psychotherapy 45 min Psychotherapy 60 min Psychotherapy 60 min.
23 Evaluation & Management Codes ADD ON CODES [ Billed with E & M Code ] Psychotherapy 30 min Psychotherapy 45 min Psychotherapy 60 min Psychotherapy 60 min.
24 Interactive Complexity Report {When at least 1 of the following factors are present} 1) The need to manage maladaptive communication among participants that complicates delivery of care. 2) Caregiver emotions/behavior that interfere with implementation of the treatment plan. 3) Evidence/disclosure of a sentinel event and mandated report to a third party with initiation of discussion of the sentinel event and /or report with patient and other visit participants. 4) Use of play equipment, physical devices, interpreter or translator to overcome barriers to diagnostic or therapeutic interaction with a patient who is not fluent in the same language or who has not developed or lost expressive or receptive language skills to use or understand typical language.
25 Pharmacologic Management Deleted Code Pharmacologic management including prescription and review of medications, when performed with psychotherapy services. { Billable with appropriate E & M code }
26 Prior Authorization The following services do not require prior authorization: Diagnostic evaluation Psychotherapy with E/M services E/M services
27 Prior Authorization The following services do require prior authorization: Individual psychotherapy Family psychotherapy Group psychotherapy
28 Case Management Licensed social workers and nurses help with: Service coordination Explaining health plan benefits Linking members with local resources Learning about our members needs
29 Health Services Contact Information Behavioral Health Unit Diana Gonzalez Case Manager Ext Aurora Arias Case Manager Ext Health Services Leadership Janel Lujan Director of Health Services Ext Irma Vasquez Administrative Supervisor Ext. 1042
30 Code The Case Scenario
31 Caregiver Emotion/Behavior Young Elementary school-aged child. For 30 minutes, during the parent portion of the visit, mother has difficulty refocusing from verbalizing her own job stress to grasp the recommended behavioral interventions for her child. Caregiver emotions/behavior that interfere with implementation of the treatment plan.
32 Maladaptive Communication An older elementary school-aged child accompanied by divorced parents, reporting declining grades, temper outbursts, and bedtime difficulties. Parents are extremely anxious and repeatedly ask questions for 45 min. about the treatment process. Each parent continually challenges the other s observation of the patient. The need to manage maladaptive communications among participants that complicates delivery of care.
33 Sentinel Event In the process of evaluation, the adolescent child reports several episodes of sexual molestations by her older brother. The allegations are discussed with parents and report is made to state agency. Evidence/disclosure of a sentinel event and mandated report to a third party with initiation of discussion of the sentinel event and/or report with patient and other visit participants.
34 Communication Barriers Group therapy for an adolescent who requires a sign language interpreter to follow the conversation in the group. Use of play equipment, physical devices, interpreter or translator to overcome significant communication barriers.
35 Psychiatric Diagnostic Evaluation Psychiatric diagnostic evaluation with medical services and an integrated biopsychosocial, and medical assessment including history, mental status, other physical examination elements as indicated and recommendations. The evaluation may include communication with family or other sources. Prescription of medications and review and ordering of laboratory or other diagnostic studies.
36 Psychiatric Diagnostic Evaluation Psychiatric diagnostic evaluation with an integrated biopsychosocial, and medical assessment including history, mental status, and recommendations. The evaluation may include communication with family or other sources..
37 Yvonne Grenz Nelly Espinoza Priscilla Gomez Meeting PCU Yolanda Ramirez Monica Sandoval Chris Valdespino Betty Vara
38 Sonia Lopez, BS, CPC Director of Claims (915) Ext: 1097 Provider Care Unit Extension Numbers: 1527 Medicaid 1512 CHIP 1509 Preferred Administrators 1504 HCO
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