BHO Coding Committee

Welcome to the Coding Committee page

The Coding Committee works in conjunction with the Department of Health Care Policy and Financing (HCPF) and the Office of Behavioral Health (OBH) annually in reviewing and revising the Uniform Service Coding Standards (USCS) Manual.  The Committee is comprised of representatives from the Behavioral Health Organizations (BHOs), Community Mental Health Centers (CMHCs) and the Community.  The Committee meets on a monthly basis to review, discuss, and update each year’s upcoming manual.

The website has several tabs that covers the names of committee members (and contact information), links to the most current USCS Coding Manual, Questions and Answers raised during the year and HCPF’s approved crosswalk for ICD-10.

We hope that you find this information helpful.  If you do have questions related to the Coding Manual, please forward the questions via email to the representative in your area.  The Committee and HCPF will review the question(s) and provide an answer.  So please keep checking back to see if your question has been addressed.

Thank-you for all the hard work you do!

Please Note: The USCS manual is a living document that is updated each year to maintain consistency between the BHO contract, the DBH contract, the State Plan Amendments, the (b)(3) waiver, and coding guidelines. Unless otherwise noted, the State (HCPF and DBH) has agreed that it will accept coding provided under all editions through July 31, 2015. Providers must implement the 2015 edition by August 1, 2015.

You can download the Manual here.

Questions Related to 2015 Coding Manual

Answer

1. H0038 – On the H0038 code page it says: “Client services (individual/group) provided by a trained, self-identified person with lived experience mental health or substance use disorder issues.” It does not reference the family member scenario that is in the definition on page 25. Can family members provide such services? Yes – By the definition on page 25, family members who meet the qualifications of a peer specialist may provide services for H0038.
2.   S9480 – Duration on S9480,   Intensive outpatient psychiatric services, per diem.  We had this code set to check for a minimum duration of 4 hours.  However, the manual isn’t clear at all on a min or max duration.  In the Duration block on the code page, there is a description of expected availability for the service: Minimum: Available 4 hours/day, 5 days/week   (page 189 of the 2015 manual) Should there be a Max Duration Identified (or clarified). No – S9480, by description, is a per diem code.   The duration of the service is defined to require that at least 4 hours of treatment must occur each day to qualify for the daily rate. The only limits for this service are that at least 4 hours of service must occur each day for up to 5 days per week.
3.   90836 –   For add-on code – 90836 – can this be used by non-medical personnel for billing purposes? No – 90836 must be used when the same prescriber provides, on the same day, both psychotherapy and an evaluation and management service (a service that must be performed by a medical professional).
4.   H0018 – H0018 allows providers to bill separately for discrete charges in certain situations involving “external providers.” (See under Note on page 123 from the coding manual) Would an “external provider” (based on the definition in this code) be anyone who is not working as part as a CSU staff member?  For example, if a care coordinator, case manager or therapist who is based at a different outpatient location goes to our CSU to work with the client, can those services be billed separately from H0018? Yes – As long as the service is not duplicative.
5.   H0015 – SUD IOP a. How should we document the various services provided as part of the IOP that are less than 180 minutes? Submit one encounter per week for IOP and then document within that each service provided?b. Family is not checked for this code, however there are several evidence based IOP group interventions that involve the family being a part of the group-how should this be noted? Should family be checked? a. The treatment should meet the ASAM criteria for this level of care. 180 minutes should not be identified as the minimum Duration. There is a need to address this with the state for further clarification.

b. Yes – Family is seen as a vital component of treatment. Coding Committee followed-up with HCPF/OBH to address this. They agree that Family treatment is a vital component of treatment and the Coding Page should allow this.

6. T1017 – Is it allowable to bill T1017 when speaking with someone from Medicaid (the BHO) regarding getting prior authorization for a service for a member. For example, nurses discussing cases with BHO for purpose of obtaining prior auth for medication. No – This is not allowed and is considered part of the cost of doing business.
7. H2030/H2031/Other 15 min Codes – There is confusion regarding the use of codes that have both a 15 minute code and a per diem code (i.e. H2030 H2031). Question is regarding the history of the change in 2013 to have both codes with 8 hour time limit, and then in 2015 to 4 hr limit for 15 min and 4-8hrs for per diem. The changes have made it difficult for IT in terms of re-programming and difficulty with use of per diem code when there are multiple providers involved in the service provision within the day. Changes were made to the 2015 Coding Manual to try and distinguish the time durations for q 15 mins vs day. Confusions still remains as to how best to address this especially when different providers do services during the day. It is up to the IT Departments to try and resolve the current issue. Further review will take place for the 2016 Coding Manual.
8.   96101/96118 – Psychological testing, code 96101 on p. 60, allows licensed psychologists and interns to bill. Neuropsychological testing, code 96118 on p. 64, allows licensed psychologists, interns, and unlicensed doctoral level staff to bill. The service descriptions for 96101 and 96118 specify “licensed psychologist.” Should unlicensed doctoral level staff be allowed for 96118? If so, shouldn’t they be allowed for 96101? Yes – Unlicensed doctoral Level should be checked on these two codes (96101 and 96118). Committee recommends to have a licensed psychologist sign off on the report/note. This will be changed in the 2016 Coding Manual.
9.   00104 (ECT) – Regarding code 00104 for Anesth, electroshock – under Unit it is marked as an encounter. How is payment being made by others……pay per unit or per charge. There is no time duration set up for Min vs Max.   What are others doing in terms of reimbursement especially if claim has the number of minutes? Acceptable to bill as one (1) fifteen (15) minute unit.
10.   H2027 – Why did we change that Bachelor’s cannot do this code? Interns are permitted, so allowing BAs would make sense. This was an error in this manual and so Bachelor staff can be used effective immediately.
11.   H2021 – BHI needs the Coding Committee’s interpretation for H2021. 2015 Manual, under Notes: …Discrete therapy services (e.g., family, group and individual psychotherapy, psychiatric services) are documented, and reported or billed separately from H2021. Please explain the intent of “or billed separately” statement. We have disagreement of interpretation whether these services are required to be billed separately or can be billed under H2021. One scenario is non-clinical staff billing case management under this code with the addition of “non” to service description. And, same question for 2014 Manual relating to clinical services for H2021. The ‘or’ portion of Notes Section is unclear. Any discrete services should be billed separately for this code.
12.  H2021/H2032 – What are the differences between these two codes?  They seem to have a lot of similarity.  Can someone explain the difference in use? H2021 is related to treatment focus while H2032 is focused on activity for all ages.  However, providers should select the most appropriate procedure code that represents the service they are rendering.  If providers are unsure which procedure code best represents the service they are providing, the provider should consult the respective BHO.
13. H2021/H2022 – Couple of questions on H2021/H2022 Community-Based Wrap-Around Services, after the team brainstorms for the plan and actions needed (white board session) they bill under the H2021/H2022 (whichever is appropriate for time spent).  Then they make the referrals, links to additional services, finishes the plan, whose responsible to do what etc, would this portion be billed as cm or also under the H2021/H2022 as well (code driven by time of course)? Providers should select the most appropriate procedure code that represents the service they are rendering.  If providers are unsure which procedure code best represents the service they are providing, the provider should consult the respective BHO.
14. 96100 – “In looking at page 302 in the USCM I could not find  code 96100 any other place in the manual. In addition starting at code 90877 the code and description lines are one off. 90887 is Consultation with Family; 96101 is Psycho testing by psych/phys; etc” Even though we haven’t been revising the OBH codes, this would still be worth bringing up and perhaps seeing if OBH is ok with us making these corrections for next year. This is indeed an error and will be corrected/clarified in the 2016 Coding Manual.
15. 90887 – Can code 90887 (p. 59) be used when presenting the results from a psychological assessment to the referring provider (a feedback session) when both parties work for the same agency? For example, the treating psychiatrist refers a consumer for psychological testing to another team in the agency. A written report will be prepared by the psychologist for the referring provider, but a presentation and discussion of the results, usually over the phone, is often done. A provider cannot use 90887 when presenting the results from a psychological assessment to the referring provider.
16. H0004 – For H0004 (fur SUD tx) family is allowed, can that be done over the telephone as well.  I know it can for individual but wasn’t sure about the family therapy (for SUD tx). Yes – please refer to code page in the 2015 Coding Manual.
17. 99366-99368 – For the 99366-99368 (team conference) it states that a minimum of 3MHPs from different specialties/disciplines.  I understand different disciplines but what defines specialty?  Is that 1 organization, such as us being a CMHC would be considered 1 specialty? No – there is a need for different credentials of the providers involved (i.e. MD, Psychologist, Medical Specialist).
18. H0023  – Outreach Services is allowed in SUD if child/adol/young adult.  Couldn’t this be opened up to Adults as well for SUD, they are just as at risk for disengaging, needing engagement efforts to bring them into tx?  We have a need for this at our MHC and honestly we have been using it. (Reference to Program Service Categories on the coding page) This code is already open to adults (see Coding Page).
19. H0002 – If in an integrated care setting, a BHP is called in to do some sort of assessment or intervention with a patient.  What are the codes the BHP should be considering?  Instead of H0002, what about H0023? Or H0031 even when done by a clinician qualified to bill 90791 but they don’t do all the required elements to bill 90791? Provider is to bill the most appropriate code for the services rendered.
20. Outpt SUD Treatment Related to DUI Therapy – patients being required by the courts to go through therapy/classes after a DUI.  If they have Medicaid can we bill for these services (ie individual, group, skills training and education services)? This is based on the SUD evaluation. If the patient meets medical necessity then it can be covered for SUD treatment and services are performed in accordance with Medicaid standards.
21. Integrated Codes – Can the code committee look at  adding these codes to next year’s code  manual to the state? Medical Nutrition Reassessment              97803 Medical Nutrition Group               97804 Medical Nutrition Therapy           97802 At this time the State does not intend to expand the scope of the BHO contracts.

Questions Related to 2015 Coding Manual

Answer

1. HF vs HE – A number of codes (see below) have the “HF (2nd modifier-SUD)” marked but not “SP(HE)”. There are r of the green HCPF procedure codes in the USCM for 2015.   It seems that there are a number of codes that can have “HF (2nd modifier-SUD)” but not “SP (HE)”. This is different from last year’s Coding Manual. Why are they marked this way now? Proc Code / Page H0045 /148 H2023/168 H2024/169 H2025/170 H2026/171 S5150/183 S5151/184 T1005/191 The codes identified have other Program Services marked. This reflects whether reimbursement is from the State as opposed to B-3 Funding.   HE is used only for State Planned Services. Please refer to page 37 in the 2015 Coding Manual for further information.
2. ET Modifier – We are trying to figure out about the ET modifier for ED evaluations.  The confusion we are having is that ED evaluations ARE included in the new statewide crisis system. When we send data to the CCC (and hence, OBH), John Mahalik and Laurie Banks have been clear that crisis services include services delivered in the community includes those clients seen in an ED, so for those services do we bill with the ET modifier? Yes – As long as the service is a an emergency service. Modifier ET represents that a procedure was emergent, but is not meant to represent that a procedure was performed in an ED; that should be notated with a proper Place of Service Code.
3. ET Modifier – Apparently we can use the ET modifier for a crisis site: 1. What is a crisis site? Is the crisis site related to the OBH crisis contract? 2. Or can any site we do crisis in be considered a crisis site, for example, if we are at outpatient waiting room, and a client is in crisis, can I use the ET modifier? a./b. There is no firm/concrete description as to what a crisis site is. Please refer back to Place of Service (POS) on the coding pages and use ET modifier to reflect Crisis Service (ET)

Questions Related to 2015 Coding Manual

Answer

1. Case Management – Why doesn’t the Mode on page 199 indicate Email as an acceptable mode of delivery (as stated on page 313) This in now brought to our attention.  At this time, Email is not considered a Mode of Delivery.  We will be looking into it and providing a formal response.
2.   Case Management – Is case management allowed for inter-agency care coordination. I thought the answer was “no” but it is referenced as “monitoring and follow-up may be with the client, family members, service providers, and other entities” on page 313 and a sample activity on page 314 states “from one program to another” or “from one agency to another”… it would be nice if it was explicitly stated ok or not ok to bill case management for internal agency care coordination. Yes –  As long as the service is not duplicative.
3.   Case Management/Bundling of Services – On page 249 it clearly states bundling is acceptable; however, it does not state how bundling is supposed to be done (i.e. same provider same day or different providers same day ok? What if some is face-to-face and other phone – does mode matter? If possible to bundle different modes, what mode is chosen and services are bundled?). No – Case Management cannot be billed for less than 8 minutes.  Please refer to the example of the bundling option.
4.   Case Management – The code page on CM T1017 does not say 8 minutes for Minimum.  It just says NA, so can we bill less than 8 minutes? No – CM cannot be billed for less than 8 minutes.  Please see the bundling option.
5.   Case Management/Other Services – Are we allowing for bundling of services other than case management, for example detox codes, such as T1007 (used for vitals monitoring which is typically less than 8 minutes, but can occur multiple times during a day)? No –  Currently this is not allowed.  The Coding Committee and HCPF will review as to the feasibility of doing so.

Questions Related to 2015 Coding Manual

Answer

1. Peer Specialists – Peer Specialists, we are seeing more Peer Specialist coming in with behavioral health degrees and does this mean they have to stay within the coding realm of Peer Specialist or can bill for services based on what the degree allows.  For example, case management requires a minimum of BA. Yes – as long as the role of peer specialist fits the scope of employment and training and proper documentation is maintained.
2.   Bachelor’s Level (HN) – Someone has a BA in organizational management,(this isn’t a behavioral health related degree but they have experience and training (not from degree)),  would they be able to bill?  We were told way back, that the degree would have to be related to the behavioral health field? The Coding Manual does not provide a definition for Bachelor’s Level.  It is up to the agency to hire staff that have the specific qualifications and training to do the job.
3.   Intern – The definition of intern on p. 28 states that interns must be from clinical programs of study that meet the minimum credentials for service provided or code billed. We interpret this to include postdoctoral fellows in a formal program with start/end dates through a university. Over the years, the term “postdoc” has been broadened to include recent doctoral graduates who are working on their hours for licensure. Because they’re often referred to as postdoc, I’ve been asked if they can be classified as interns for billing of the testing codes. No –   Not allowed to mark as Interns.  Instead check as an Unlicensed EdD/PhD/PsyD (HP).  The 2016 Coding Manual will provide a definition for “Unlicensed EdD/PhD/PsyD (HP).
4.  SUD Care Management – does it require a SUD experienced provider to provide CM services?  Provider in question is linking to BH services and has a BA. Use the credentials as it stands on the Coding Page.

Questions Related to 2015 Coding Manual

Answer

1. POS 14 vs POS 56 – What is the difference between POS 14 – Group Home and POS 56 – PRTC? A CMHC disagrees with the recommendation to use POS 56 over POS 14. As far as which POS to use depends on the licensing of the facility and where the service isactually rendered (actual location).   A resource to use is the website related to PRTFCO – there one will find the licensed facilities for this level of care. If facility is on the list – use 56 as POS
2. Drop-In center for child/adolescent – requires a monthly survey by member. During the drop-in center the clients are in school and parents/guardians access the services under the “family benefit”. Can the parent or guardian complete the survey without the member being present? No. Drop-in center services are for patients not collaterals. It is specified for people with mental illnesses.

Questions Related to 2015 Coding Manual

Answer

1.  Deferred Diagnoses – Since Deferred Dx is no longer in DSM V – what is to be used instead? For V71.09 use R69 and for V71.09 use Z03.89.
2.  Deferred Diagnoses – Use with Prevention and Assessment Codes Just confirming that the use of either R69 or Z03.89 are acceptable to use with prevention and assessment codes that don’t require a covered diagnosis. This question comes from an FQHC, wanting to make sure that all BHOs are in agreement on this. Yes – this is acceptable.

Questions Related to 2015 Coding Manual

Answer

1. UB-04 – Does anyone with the coding committee know if the Community Mental Health Centers can bill on a UB-04 and if so which services apply to this type of billing? No – Only facilities are to use UB-04

*Last updated 3/14/16

Download the July 2016 chart here.

Committee Members: email address: Agency:
Ann(Winters)Doering awinters@bhiinc.org BHI
Bonnie Wright bwright@bhiinc.org BHI
Frank Cornelia fcornelia@cbhc.org CBHC
Tina McCrory tinam@chnpartners.com CHP
Lindsay Cowee lindsay.cowee@coaccess.com CO Access
Camree Sutton c.sutton@communityreachcenter.org Community Reach Ctr
Kiara Kuenzler kkuenzler@fbhpartners.com FBHP
Kari Snelso ksnelson@fbhpartners.com FBHP
Samatha Kommana samathak@health.solutions Health Solutions
Darla Keller darlak@health.solutions Health Solutions
Bill Pierini bill.pierini@mhcd.org MHCD
Jill McFadden jmcfadden@mhpcolorado.org MHP
Erin Weber (Cantiberry) eweber@mindspringshealth.org Mind Springs
Deanna Ryerson deanna.ryerson@northeastbho.org Northeast Behavioral Health
Erik Stone estone@signalbhn.org Signal
Amie Adams amiea@solvistahealth.org Sol Vista
Mita Johnson mitamjohnson@comcast.net SUD