Resolved Mobile Crisis Billing and Coding

[DevinH_48882]

I am looking to see if anyone has any experience with Mobile Crisis Billing & Coding. My employer has a Mobile Crisis unit which provides services to children and teens, and I have been trying to find information all over but haven't really had any luck. I am trying to find tips on proper documentation and coding for the most part.

I have found the following codes (dependent on the scenario and/or payer as well as time):

1. CPT 90839 - Psychotherapy for crisis; first 60 minutes: This code seems more appropriate when the patient is showing life-threatening or highly complex psychiatric crisis, and not when the patient is in a "minor" crisis state (ex. child who is not willing to go to school, causing disruption in the house by screaming and slamming doors and the parent calls the MC department to help come and calm the child - this code would not be appropriate)
2. HCPCS S9484 - Crisis intervention mental health services, per hour (CT Medicaid and some commercial carriers): This code seems more appropriate when the patient may be experiencing a crisis situation and is unable to cope and calm themselves with resources at hand, which then caused the MC team to be called to the home, school etc. (ex. child who is not willing to go to school, causing disruption in the house by screaming and slamming doors and the parent calls the MC department to help come and calm the child - this code would be appropriate)
3. HCPCS H2011 - Crisis intervention service, per 15 minutes: Crisis intervention mental health services, per hour (CT Medicaid and some commercial carriers): This code seems more appropriate when the patient may be experiencing a crisis situation and is unable to cope and calm themselves with resources at hand, which then caused the MC team to be called to the home, school etc. (ex. child who is not willing to go to school, causing disruption in the house by screaming and slamming doors and the parent calls the MC department to help come and calm the child - this code would be appropriate)

Any insight and/or resources would be greatly appreciated

 

[Darcy]

This is what I found;

• Thoroughly document the crisis situation: Include a description of the crisis, an urgent assessment, and the client's history of the crisis state.
• Conduct a full mental status exam: Ensure all relevant aspects are documented.
• Detail psychotherapy interventions: Explain how interventions were used to minimize potential psychological trauma.
• Document resource mobilization: Describe any resources used to defuse the crisis and restore safety.
• Outline the treatment plan: Clearly state the next steps for the client.
• Accurately record time spent: Document the exact number of minutes or start/stop times spent with the client, providing psychotherapy for crisis.
• Establish Medical Necessity: Clearly document the urgency and complexity of the crisis, demonstrating the necessity of the intervention.
• Structured Documentation: Employ a structured note format that includes start and end times, the nature of the crisis, therapeutic techniques used, the patient's response, and next steps.
• Document Communication: Include details of communication with contacts who may have pertinent information for the assessment.
• Note Substance Use (if applicable): Document if substance use is a factor in the crisis.
• Document the Outcome of the Session: Describe the client's response to interventions and their disposition.
• Avoid incomplete documentation: Incomplete documentation can lead to coding errors and denied claims, according to Brown Consulting Associates.
• Utilize standardized templates and checklists: These tools can help ensure consistency and completeness in documentation.
• Coordinate with other providers: Document communication and collaboration with other healthcare providers or community resources involved in the patient's care.

Coding tips for mobile crisis billing and coding

• Use the Correct CPT Codes: CPT code 90839 is used for the first 60 minutes of psychotherapy for crisis, and CPT code 90840 is an add-on code for each additional 30-minute increment.
• Time-Based Billing Compliance: CPT 90840 applies only to sessions lasting beyond 74 minutes. For sessions exceeding 104 minutes, bill additional units of CPT 90840.
• Use Specified Diagnosis Codes: Opt for specific diagnoses instead of general ones.
• Bill for After-Hours Services: Use add-on CPT code 99050 for services furnished outside of normal business hours and CPT add-on code 99051 for services rendered during scheduled holiday, weekend, or evening hours.
• Telehealth Services: Use Place of Service code 02 along with appropriate telehealth modifiers (95 or GT, depending on the insurance company's guidelines) when providing crisis therapy via telehealth.
• Verify Insurance Policies: Before billing, confirm whether telehealth crisis sessions are covered by the payer.
• Avoid Incorrect Coding: Regularly audit coding practices to identify and correct errors, notes Brown Consulting Associates.
• Do not bill crisis psychotherapy codes for standard therapy sessions: Crisis codes should only be used when a session involves an immediate, high-intensity response to a psychiatric crisis that requires urgent intervention.
• Use HCPCS codes G0017 and G0018 to bill for services furnished in a non-office setting.
• Medicare reimbursement rate: The Medicare reimbursement rate for CPT code 90839 in 2025 is $148.47.
• Do not bill psychotherapy for crisis codes with: 90791, 90792, 90785-90899, or 90832-90838.