Medical billing and coding can become complicated, fast. The large number of terminology, acronyms, and codes used for CPT, ICD-10, and the DSM 5 can make anyone’s head start to swim. Choosing even one wrong code during a claim can be a costly mistake for the biller and the practitioner, so knowing the most common mental health billing codes for mental and behavioral health is key when perfecting the art of medical billing.

Mental Health Billing Codes: CPT Codes

Current Procedural Terminology is a standardized set of codes that is maintained by the American Medical Association (AMA) and is used for services such as psychology, psychiatry, and other behavioral health services. Essentially, CPT codes illuminate the treatment or action provided to the clients of mental health professionals. Whether it is a therapy session or a trip to the ER, every CPT code has its place in the world of medicine.

Using the wrong CPT codes for a claim can result in a claim denial and a blip in the pay cycle. The health of any practice depends on a competent medical biller and coder; two of the most common issues with CPT codes is under-coding and up-coding, which refers to a CPT code that represents a lower price treatment or higher price treatment in comparison to the actual service provided. These are both illegal practices, whether or not it is done with altruistic or malicious intent. For example, a practitioner may try to save money for a patient by undercoding, or get more money than the actual service was worth via upcoding. Most of the time, undercoding and upcoding is not done with an ulterior motive, but it is illegal due to the reasons listed above.

Psychotherapy has a designated 24 codes; this is a relief to mental health billers, as there are over 8,000 CPT codes in use. For therapists, these are the most commonly used CPT codes:

  • 90791 – Psychiatric Diagnostic Evaluation
  • 90792 – Psychiatric Diagnostic Evaluation with medical services
  • 90832 – Psychotherapy, 30 minutes (16-37 minutes)
  • 90834 – Psychotherapy, 45 minutes (38-52 minutes)
  • 90837 – Psychotherapy, 60 minutes (53 minutes and over)
  • 90846 – Family or couples psychotherapy, without patient present
  • 90847 – Family or couples psychotherapy, with patient present
  • 90853 – Group Psychotherapy (not family)
  • 90839 – Psychotherapy for crisis, 60 minutes (30-74 minutes).

ICD-10 and DSM 5 Codes

ICD and DSM codes are used for specific diagnoses of medical conditions. The World Health Organization’s International Classification of Diseases and Related Health Problems – or ICD codes – correspond with CPT codes to help medical billers bill insurance companies. The Diagnostic and Statistical Manual of Mental Disorders is

the brain is a puzzle

managed by the American Psychiatric Association and is used to diagnosis mental health conditions; DSM 5 codes and ICD-10 codes are the same. Basically, the DSM is a guide to choosing the right ICD code.

The most common ICD 10 codes for mental and behavioral health therapists and practitioners are:

  • 9 Major depressive disorder, single episode, unspecified
  • 0 Major depressive disorder, single episode, mild
  • 1 Major depressive disorder, single episode, mild
  • 1 Major depressive disorder, single episode, moderate
  • 2 Major depressive disorder, single episode, severe without psychotic features
  • 3 Major depressive disorder, single episode, severe with psychotic features
  • 4 Major depressive disorder, single episode, in partial remission
  • 5 Major depressive disorder, single episode, in full remission
  • 8 Other depressive episodes
  • 1 Major depressive disorder, recurrent, moderate
  • 2 Major depressive disorder, recurrent severe without psychotic features
  • 3 Major depressive disorder, recurrent, severe with psychotic symptoms
  • F39 Unspecified mood [affective] disorder
  • 9 Schizoaffective disorder, unspecified; See also:
    • 0­ Schizoaffective disorder, bipolar type,
    • 1­ Schizoaffective disorder, depressive type,
    • 8­ Other schizoaffective disorders
  • F29 Unspecified psychosis not due to a substance or known physiological condition
  • 9 Anxiety disorder, unspecified
  • 1 Generalized anxiety disorder
  • 8 Other specified anxiety disorders
  • 0 Panic disorder [episodic paroxysmal anxiety] without agoraphobia
  • 1 Generalized anxiety disorder
  • F42 Obsessive­-compulsive disorder
  • 1 Agoraphobia with panic disorder
  • 0 Attention-­deficit hyperactivity disorder, predominantly inattentive type
  • 1 Attention-­deficit hyperactivity disorder, predominantly hyperactive type
  • 2 Attention-­deficit hyperactivity disorder, combined type
  • 8 Attention­-deficit hyperactivity disorder, other type
  • 9 Attention­-deficit hyperactivity disorder, unspecified type
  • 0 Alzheimer’s disease with early onset
  • 1 Alzheimer’s disease with late onset
  • 8 Other Alzheimer’s disease
  • 9 Alzheimer’s disease, unspecified
  • 9 Bipolar disorder, unspecified
  • 0 Bipolar disorder, current episode hypomanic
  • 10 Bipolar disorder, current episode manic without psychotic features, unspecified
  • 11 Bipolar disorder, current episode manic without psychotic features, mild
  • 12 Bipolar disorder, current episode manic without psychotic features, moderate
  • 13 Bipolar disorder, current episode manic without psychotic features, severe
  • 30 Bipolar disorder, current episode depressed, mild or moderate severity, unspecified
  • 31 Bipolar disorder, current episode depressed, mild
  • 20 Opioid dependence, uncomplicated
  • 21 Opioid type dependence in remission
  • 220 Opioid dependence with intoxication, uncomplicated
  • 221 Opioid dependence with intoxication delirium
  • 22 Opioid dependence with intoxication with perceptual disturbance
  • 10 Posttraumatic stress disorder, unspecified
  • 11 Posttraumatic stress disorder, acute
  • 12 Posttraumatic stress disorder, chronic
  • 23 Adjustment disorder with mixed anxiety and depressed mood
  • 891 Long term (current) use of opiate analgesic
  • 899 Other long term (current) drug therapy
  • 89 Encounter for observation for other suspected diseases and conditions ruled out

Rejected ICD-10 Claim Codes

According to the AAPC, “For a medical provider to receive reimbursement for medical services, ICD-10-CM codes are required to be submitted to the payer. While CPT® codes depict the services provided to the patient, ICD-10-CM codes depict the patient’s diagnoses that justify the services rendered as medically necessary.”

In simple terms, if the insurance provider rejects your ICD-10 code, they wont cover the services you provided to your patient, and you wont get paid.

To prevent rejected insurance claims our team:

  • Has decades of submitting ICD-10 codes for mental health billing, psychologists, and neuro psychologists.
  • We follow-up on any rejected, up-coded, or under-coded insurance claims
  • We follow the best practices according to the AAPC
  • We increase billing revenues with our proven systems, billing specialists, billing processes & years of experience

Need a Remote Medical Biller in LA County, LA

The Psych Biller specializes in remote medical billing and coding for mental health services such as psychologist and psychiatrist offices. We are a one-stop-shop for boutique medical billing, mental health office support, and psychology billing for all small business needs. Cut costs on overhead, storage, and labor by working with The Psych Biller today! Put almost 2 decades of experience to use by calling (800) 955-3461 to know more about mental health billing codes.