Coding and Billing in a Biofeedback Practice

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Coding and Billing in a Biofeedback Practice

• Ronald L. Rosenthal, Ph.D.

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authorization is not a guarantee of payment
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Contextual Background

• Federal Policy
• State Statutes
• Insurance Regulations/LMRP
• Business Practices
• Clinical Theoretical Orientation

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Practice Models (or how to get the money)

• Fee for Service

• Third Party Reimbursement

• Mixed Collection Methods

• Section 403(c)

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Provider Panels

• Can increase the number of patients

• Restricts your ability to set fees

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Billing Prerequisites

• Diagnostic Code

• Procedure Code

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Diagnostic Coding

• DSM IV for psychological disorders

• ICD-10 for physical disorders

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Procedure Codes

• Current Procedual Terminology (CPT code book)

• Primarily oriented to physicians and treatment of
  physical ailments

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(No Transcript)
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Biofeedback Codes

• 90901 Biofeedback training by any modality

• 90911 Biofeedback training, perineal muscles,
  anorectal or urethral sphincter, including EMG
  and/or manometry

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Biofeedback and Psychotherapy Combination Codes

• 90876 Individual psychophysiological therapy
  incorporating biofeedback training by any
  modality (face to face with the patient), with
  psychotherapy (eg, insight oriented, behavior
  modifying or supportive psychotherapy) 45-50
  minutes

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Retired Biofeedback Codes

• Prior to 1997 (the Golden Age) there were
  multiple codes specific for modalities of
  biofeedback 90900, 90902, 90904, 90906, 90908,
  90910 and 90915.

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Alternative Codes For Biofeedback

• 97112 Neuromuscular reeducation of movement,
  balance, kinesthetic sense, posture, and/or
  proprioception for sitting and/or standing
  activities.

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Alternative Codes For Biofeedback

• 97532 Development of cognitive skills to
  improve attention, memory, problem solving,
  (includes compensatory training).
• Formerly 97770

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Health and Behavior Assessment And Intervention
Codes
These codes describe services to patients who
present with established illnesses or symptoms,
who are not diagnosed with mental illness, and
may benefit from evaluations that focus on the
biopsychosocial factors related to the patients
physical health status.
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Rationale Specific Examples

• Patient Adherence to Medical Treatment
• Symptom Management Expression
• Health-promoting Behaviors
• Health-related Risk-taking Behaviors
• Overall Adjustment to Medical Illness

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Overview of Codes

• New Subsection
• Six New Codes
• Assessment
• Intervention
• Established Medical Illness or Diagnosis
• Focus on Biopsychosocial Factors

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Relative Values for Health Behavior Codes

• 96150 Assessment RVU .50
• 96151 Reassessment RVU .48
• 96152 Intervention RVU . 46
• 96153 Group RVU .10
• 96154 Family (with pt) RVU .45
• 96155 Family (w/o pt) RVU .44

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Reimbursement Rates and Relative Value Units
(RVUs)

• Three components
• Physician Work
• Practice Expense
• Liability Insurance

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Relative Value Units and Reimbursment (2)

• The RVU is multiplied by a conversion factor to
  determine payment
• Biofeedback codes have modest RVUs

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Neurofeedback Evaluation Codes

• 95816 Digital EEG recording

• 95957 Digital EEG analysis
• 99090 Reference EEG database access

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Modes of Claim Submission

• Hard Copy--Mailed

• Electronic Transmission

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Modes of Claim Submission

• Hard Copy--Mailed

• Electronic Transmission

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Electronic Submission of Bills and HIPAA

• HIPAA compliance mandated when an office engages
  in electronic transmission of information.

• Small offices are exempted from HIPAA compliance
  if they do not use electronic transmission of
  information.

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Problems with Biofeedback Codes

• Not universally covered.
• May require prior authorization.
• Limitations on number of sessions.
• Limitations on types of patients/disorders
  eligible for reimbursement.
• Poor reimbursement rates.
• Time consuming to get authorization.

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Medicare and Biofeedback

• Requires the use of a modifier (GP for physical
  therapy) for payment.
• There is a cap on outpatient
  rehabilitation services (less than 2000/year).

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Medicare and Biofeedback

• Rehabilitation professionals are trying to have
  the cap eliminated (The Medicare Access to
  Rehabilitation Services Act of 2007).

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Medicare and Biofeedback

• Medicare standards often adopted by
  other insurance companies.
• Coverage only for muscular retraining.
• Excludes 90876.
• Limited diagnostic codes eligible.
• Payment is less than 45 regardless of the
  length of session for 90901.