99423 – Telehealth / Remote Behavioral Health Service
CPT code 99423 represents a distinct mental or behavioral health service, including evaluation, therapy, or care coordination.
What is CPT
99423
?
99423 is a CPT code designated for the provision of remote or virtual care, specifically within the context of telehealth services. This entry provides a comprehensive overview of the clinical applications, documentation requirements, and payer considerations associated with this code. Providers are encouraged to ensure their clinical notes reflect evidence-based interventions, accurately documenting treatment goals, the interventions employed, and measurable outcomes achieved during the session. When billing for services under this code, particularly those that are time-based, it is critical to record precise start and stop times to substantiate the billed duration effectively.
Documentation Tips
Accurate documentation is crucial for the successful billing of CPT code 99423. Providers should ensure they document the following elements:
- Start and Stop Times: Clearly record the time the session begins and ends, especially when billing for psychotherapy services that are time-based.
- Therapeutic Modality: Specify the therapeutic approach or assessment instrument utilized during the session, such as cognitive behavioral therapy (CBT) or a specific scoring tool.
- Clinical Focus: Describe the primary issues addressed during the session and the interventions applied.
- Patient Response: Note the patient’s engagement and progress throughout the session, including any changes in symptomatology.
- Plan for Follow-Up: Outline the next steps for treatment, including any referrals or additional assessments needed.
- Consent and Platform Details: For telehealth sessions, document patient consent for virtual care and provide details of the telecommunication platform used.
Utilizing a consistent structure such as SOAP (Subjective, Objective, Assessment, Plan) or DAP (Data, Assessment, Plan) can enhance audit readiness and ensure compliance with payer requirements.
At a Glance
- Service Type: Telehealth
- Use Case: Remote / Virtual Care
- Typical Setting: Outpatient clinic or telehealth, subject to payer policies
- Billing Unit: Per session or per instrument, which may vary based on specific coding
- Common Pairings: 90791 (Psychiatric Diagnostic Evaluation), 96127 (Brief Emotional/Behavioral Assessment), various psychotherapy codes
Billing Examples
A telehealth consultation using CPT code 99423 should closely resemble the documentation of an in-person visit, while incorporating specific details unique to virtual interactions. For instance, a clinician may document: "The session commenced at 10:00 AM on the Zoom platform, with verbal consent obtained from the patient to proceed with telehealth. The patient discussed increased anxiety levels, and we engaged in CBT techniques to address these concerns. The session concluded at 10:30 AM, with a follow-up scheduled in one week to reassess and adjust the treatment plan as necessary." This documentation effectively captures the essence of the telehealth encounter.
It is important to note that billing for telephone consultations or asynchronous communications may require different CPT codes, and these services often have their own reimbursement policies. Clinicians should familiarize themselves with these distinctions to ensure accurate coding and billing practices.
Compliance Guidelines
- Confirm payer coverage and authorization requirements prior to service delivery to avoid claim denials.
- Document medical necessity thoroughly, linking the services provided to appropriate ICD-10 diagnoses to meet compliance standards.
- Utilize correct modifiers, such as modifier 95, to indicate that the service was delivered via telehealth as required by many payers.
- Avoid the practice of upcoding; select codes that accurately reflect the documented time and complexity of the service provided.
- Conduct regular audits of documentation practices to identify areas for improvement, reduce claim denials, and enhance the overall quality of clinical records.
Common ICD-10 Codes
Helpful links for mental health billing and documentation
- F41.1 (Generalized Anxiety Disorder)
- F32.0 (Major Depressive Disorder, Single Episode, Mild)
- Z04.8 (Encounter for Other Specified Examination)
- F43.21 (PTSD, Chronic)
Additional Resources
Helpful links for mental health billing and documentation
Related CPT Codes
Helpful links for mental health billing and documentation
Got questions? We’ve got answers.
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Q1: What is the primary use of this code?
A: CPT code 99423 is utilized when remote clinical activities align with the code's definition; it is imperative that documentation supports the services billed under this code.
Q2: Is it possible to bill this code via telehealth?
A: Yes, many payers reimburse telehealth services, provided that the service is delivered synchronously and that all necessary modifiers and consent documentation are in place. Always verify with the specific payer's policy.
Q3: What types of documentation might payers request?
A: Payers typically request documentation that includes time spent, specific therapeutic techniques or instruments utilized, patient responses to interventions, and a clear linkage to a covered ICD-10 diagnosis.
Q4: Can CPT code 99423 be billed alongside other services?
A: Yes, when billing multiple services, it is essential to document distinct time spent and rationale for each service. Use add-on codes or follow evaluation and management (E/M) separation rules as applicable.
Q5: What are common reasons for claim denials?
A: Common denial reasons include missing or incorrect time records, insufficient documentation of medical necessity, improper use of modifiers, or billing for services beyond frequency limits established by payers.
