Transcription

Regulations andGuidanceDocumentation Templates3.0.0 Updated 12-8-16 Progress NotesEvaluation and Management (E & M)Complex Care / Crisis Intervention / Contact NoteHealth Monitoring / Injectable Psychotropic MedicationAdministration / with Monitoring and EducationPre-Admission / Admission Decision NotePsychotherapy / Contact Treatment PlansDischarge Summary / Plan – Part APatient Safety Plan TemplateRelapse Prevention PlanTreatment / Recovery PlanTreatment / Recovery Plan Review/Revision Assessments and AddendaComprehensive AssessmentHealth ScreenMedication ListSubstance Use / Addictive Behaviors AssessmentMilitary Assessment (Addendum)Military Assessment for Significant Others (Addendum)Self-AssessmentPart 599 RegulationsPart 599 Guidance DocumentClinic Standards of Care:Anchor ElementseMedNY manualsOMH APG Wt. & RatesAdditional ResourcesNYSCRI v3.0.0 Release Notes(12-8-16)NYSCRI (OMH) ComplianceGridDownload Adobe Readerto work with the templatesWorkflowProcedures / Services Initial AssessmentPsych Assessment - 30Psych Assessment - 45Psychiatric Consultation -30Psychiatric Consultation - 45Crisis InterventionInjectable Psychotropic MedicationAdministrationInjectable Psychotropic Med.Admin./with Monitoring and EducationPsychotropic Medication TreatmentPsychotherapy:- Individual - 30- Individual - 45- Family- GroupDevelopmental TestingPsychological TestingComplex Care ManagementHealth PhysicalsHealth MonitoringSmoking CessationSBIRTTreatment Plan and Review (Rules)Pre-Admission (Rules)Discharge (Rules)Credential Guidance

A-31/599 Mental Health Clinic Rules – Model Encounter Form – New OMH RulesSection ACheck boxes if applicable:APGCPT Procedure – OMH Regulatory NameCPT Codes 323Initial Assessment Diagnostic & Treatment Plan – 45 minutes 90791323Initial Assessment Diagnostic & Treatment Plan with Medical Services– 45Minutes 90792820-831Psychiatric Assessment – 30 minutesSection B820-831Psychiatric Assessment – 45-50 minutesSection B820-831Psychiatric Consultation - New/Established PatientSection B321Crisis Intervention – 15 minutes H2011321Crisis Intervention – per hour S9484312Crisis Intervention – per diem S9485N/AInjectable Psychotropic Medication Administration – No minimum time 96372(Professional Claim- no rate code)490820-831Injectable Psychotropic Medication Admin with monitoring and education - 15 H2010minutesPsychotropic Medication Treatment- DX BasedSection B315Psychotherapy – Individual – 30 minutes 90832316Psychotherapy – Individual – 45 minutes 90834317Psychotherapy – Family with or without the client– 30 minutes 90846317Psychotherapy – Family & Client – 1 hour 90847318Psychotherapy – Family Group – 1 hour 90849318Psychotherapy – Group – 1 hour 90853310Developmental Testing – limited 96110310Developmental Testing – extended 96111310Psychological Testing – Various 96101310Psychological Testing – Neurobehavioral 96116310Psychological Testing – Various 96118490Complex Care Management – by units820-831(9/24/14 New Rule) 90882Health Physicals – New/Established PatientSection B490Health Monitoring – 15 minutes 99401490Health Monitoring – 30 minutes 99402490Health Monitoring – 45 minutes 99403490Health Monitoring – 60 minutes 99404490Health Monitoring Group – 30 minutes 99411490Health Monitoring Group – 60 minutes 99412451Smoking Cessation Treatment 3-10 minutes (Dx code 305.1) 99406451Smoking Cessation Treatment 10 minutes (Dx code 305.1) 99407451Smoking Cessation Treatment Group 10 minutes (Dx code 305.1) 99407-HQSBIRTH0049 or H0050LOEAfterHoursOffsiteMD/NP

Section BAPG820-831Check boxes if applicable:CPT Procedure – OMH Regulatory NamePsychiatric Assessment – 30 minutes – Select CPT Code from Range:NewEstablished 99201 99204 99212 99215 99202 99205 99213 99203 99214CPT Codes Schizophrenia 821Major Depressive Disorders & Other Psychoses 822Disorders of Personality & Impulse Control 823Bipolar Disorders 824Depression Except Major Depressive Disorder 825Adjustment Disorders & Neuroses 826Acute Anxiety & Delirium States 827Organic Mental Health Disturbances 829Childhood Behavioral Disorders 830831Eating DisordersOther Mental Health Disorders 315OffsiteMN/NP 90833Psychiatric Assessment – 45-50 minutes – Select CPT Code from Range:NewEstablished 99201 99204 99212 99215Select Diagnosis: 99202 99205 99213 99203 99214Psychiatric Assessment – 30 minutes – ADD ON820821SchizophreniaMajor Depressive Disorders & Other Psychoses 822Disorders of Personality & Impulse Control 823Bipolar Disorders 824Depression Except Major Depressive Disorder 825Adjustment Disorders & Neuroses 826Acute Anxiety & Delirium States 827Organic Mental Health Disturbances 829Childhood Behavioral Disorders830Eating Disorders 831Other Mental Health Disorders 316Psychiatric Assessment – 45-50 minutes – ADD ON820-831AfterHoursSelect Diagnosis: 820820-831LOE 90836Psychiatric Consultation – New/Established Patient – 30; 45 - Select CPT Code from Range:NewEstablished 99201 99204 99212 99215Select Diagnosis: 99202 99205 99213 99203 99214820Schizophrenia 821Major Depressive Disorders & Other Psychoses 822Disorders of Personality & Impulse Control 823Bipolar Disorders 824Depression Except Major Depressive Disorder 825Adjustment Disorders & Neuroses 826Acute Anxiety & Delirium States 827Organic Mental Health Disturbances 828Mental Retardation 829Childhood Behavioral Disorders 830831Eating DisordersOther Mental Health Disorders 2

820-831820Psychotropic Medication Treatment- DX BASED – Select CPT Code from Range:New 99201 99204 99202 99205 99203SchizophreniaEstablished 99212 99215 99213 99214Select Diagnosis: 821Major Depressive Disorders & Other Psychoses 822Disorders of Personality & Impulse Control 823Bipolar Disorders 824Depression Except Major Depressive Disorder 825Adjustment Disorders & Neuroses 826Acute Anxiety & Delirium States 827Organic Mental Health Disturbances 829Childhood Behavioral Disorders 830Eating Disorders 831Other Mental Health Disorders 820- 831 Health Physicals – New/Established Patient – Select CPT Code from RangeNew 99382 99385 99383 99386 99384 99387SchizophreniaEstablished 99392 99395 99393 99396 99394 99397Select Diagnosis: 821Major Depressive & Other Psychoses 822Disorders of Personality & Impulse Control 823Bipolar Disorders 824825Depression Except Major Depressive DisorderAdjustment Disorders & Neuroses 826Acute Anxiety & Delirium 827Organic Mental Health Disturbances 820829Childhood Behavioral830Eating Disorders831Other Mental Health Disorders

NYSCRI Dashboard – Article 31 choanalystsAbbreviated OMH Part 599Guidance. Please refer to the fullPart 599 guidance document(2015)Initial assessment is a face-toface interaction between aclinician and recipient and/orcollaterals to determine theappropriateness of the recipientfor admission to a clinic, theappropriate mental healthdiagnosis, and the developmentof a treatment plan for suchrecipient.Note: This service requires anassurance that a health screeninghas been done and is documentedin the recipient’s record.Abbreviated Rules for billingMedicaid Fee for Service(FFS)eMed N Y billing providermanuals&OMH APG Wt. & RateNo more than 3 initialassessments allowed during anepisode of illness, or within 365days of the last providedservice.Notes: This service may beprovided as all or part of thecompletion of a ComprehensiveAssessment (CA). In order to bebillable, the CA form andprocess must relate directly to abillable CPT/HCPCS 5 minutesOMH Standards ofCare Initial90792Assessment- withmedicalservice99051U4AFAGSAMDNPPSame as 90791 Medicalservices, which includebiopsychosocial and medicalassessment, including history,mental status, other physical examelements as indicated andrecommendations.Same service limitations asabove.This service must be providedby a physician or PsychiatricNurse Practitioner (NPP).This service may beprovided to the client and/orcollateral.Sessions less than 45 minuteswill not be reimbursed byMedicaid.Rounding is not permitted.45 minutes Pre-admission /Admission DecisionComprehensiveAssessmentHealth ScreenAs indicated:MilitaryAssessment (MA) &MA Sig. OtherPatient Safety PlanTemplateSubstance UseAssessmentRelapse PreventionPlanSelf-AssessmentEvaluation andManagement(E & M)ComprehensiveAssessmentHealth ScreenOthers noted above,as Needed

NYSCRI Dashboard – Article 31 ClinicOMHTitlePsychiatricAssessment- 30 PPA withspecializedtrainingapproved byOMH99051Abbreviated OMH Part 599Guidance. Please refer to the fullPart 599 guidance document(2015)An interview with an adult or child orhis or her family member or othercollateral, performed by apsychiatrist or nurse practitioner inpsychiatry, or physician assistantwith specialized training approvedby the Office.Abbreviated Rules for billingMedicaid Fee for Service(FFS)eMed N Y billing providermanuals&OMH APG Wt. & RateNYSCRIDocumentationTemplatesMinimumDurations30 minutesService requires documentedface-to- face contact with therecipient or collateral of at least30 minutes. To be reimbursedproperly for a 30 minutePsychiatric Assessment, theclinic must report an office E&Mcode (based on complexity) ononeclaim line and 90833 on theA psychiatric assessment may occursecondclaim line. Note: 90833at any time during the course ofisnotconsidereda separatetreatment, for the purposes ofservice, it will not be discounteddiagnosis, treatment planning,by 10%.medication therapy, and/orconsideration of general healthNotes: This service may beissues.provided as all or part of theThe psychiatric assessment may be completion of a Comprehensiveprovided at pre- or post-admission. Assessment (CA). In order to bebillable, the CA form and processIf at pre-admission, the service willcount toward the cap of 3 services. must relate directly to a billableCPT/HCPCS code.OMH Standards ofCare E&MOthers as noted in firstrow, plus any new oradditional relevantinformation.Document on the samenote as above.

NYSCRI Dashboard – Article 31 ClinicOMHTitlePsychiatricAssessment- 45 E&MU4Code(Rangeof 6NoRequiredCredentialPsychiatristNPPPA withspecializedtrainingapproved byOMHAbbreviated OMH Part 599Guidance. Please refer to the fullPart 599 guidance document(2015)An interview with an adult or child orhis or her family member or othercollateral, performed by apsychiatrist or nurse practitioner inpsychiatry, or physician assistantwith specialized training approvedby the Office.Abbreviated Rules for billingMedicaid Fee for Service(FFS)eMed N Y billing providermanuals&OMH APG Wt. & RateNYSCRIDocumentationTemplatesMinimumDurations45 minutesService requires documentedface-to- face contact with therecipient or collateral of at least30 minutes. To be reimbursedproperly for a 30 minutePsychiatric Assessment, theclinic must report an office E&Mcode (based on complexity) ononeclaim line and 90833 on theA psychiatric assessment may occursecond claim line. Note: 90833at any time during the course ofis not considered a separatetreatment, for the purposes ofservice, it will not be discounteddiagnosis, treatment planning,by 10%.medication therapy, and/orconsideration of general healthNotes: This service may beissues.provided as all or part of theThe psychiatric assessment may be completion of a Comprehensiveprovided at pre- or post-admission. Assessment (CA). In order to bebillable, the CA form and processIf at pre-admission, the service willcount toward the cap of 3 services. must relate directly to a billableCPT/HCPCS code.OMH Standards ofCare E&MOthers as noted in firstrow, plus any new oradditional relevantinformation.Document on the samenote as above.

NYSCRI Dashboard – Article 31 ClinicOMHTitlePsychiatricConsult- 30 15)Established ialPsychiatristNPPPA withspecializedtrainingapproved bythe OMHAbbreviated OMH Part 599Guidance. Please refer to the fullPart 599 guidance document (2015)Psychiatric consultation means a faceto-face evaluation, which may be in theform of video telepsychiatry, of aconsumer by a psychiatrist or nursepractitioner in psychiatry, including thepreparation, evaluation, report orinteraction between the psychiatrist ornurse practitioner in psychiatry andanother referring physician for thepurposes of diagnosis, integration oftreatment and continuity of care.Guidance: This service is intended tosupport primary care doctors in theirtreatment of individuals with mentalillness. Consultation services cansupport:1. The treatment of mental illness inprimary care settings; or2. The transition from clinic basedmental health care to primary caremental health treatment.Abbreviated Rules forbillingMedicaid Fee for Service(FFS)eMed N Y billingprovider manuals&OMH APG Wt. & RateFor this service, the referringphysician cannot beemployed by the clinicproviding the consultation.A consultation must meet thefollowing conditions:1. It must be performed at therequest of another physicianrequesting advice regardingevaluation and/ormanagement of a specificproblem;2. The request for theconsultation and the reasonfor it must be recorded in thepatient’s medical record; and3. A written report must beprepared on the findings andprovided to the MinimumDurations30 minutesOMH Standards ofCare E&M

NYSCRI Dashboard – Article 31 ClinicOMHTitlePsychiatricConsult- 45 15)Established Same asAboveAbbreviated OMH Part 599Guidance. Please refer to the fullPart 599 guidance document(2015)Same as AboveAbbreviated Rules for billingMedicaid Fee for Service(FFS)eMed N Y billing providermanuals&OMH APG Wt. & RateSame as 5 minutesOMH Standards ofCare E&M

NYSCRI Dashboard – Article 31 edPsychoanalystsAbbreviated OMH Part 599Guidance. Please refer to the fullPart 599 guidance document(2015)(1) Crisis Intervention - Brief.Abbreviated Rules for billingMedicaid Fee for Service(FFS)eMed N Y billing providermanuals&OMH APG Wt. & RateMinimumDurationsCrisis Intervention – Brief can be 1) 15 minreimbursed by Medicaid fee-forThis may be done face-to-face or byservice for individuals regardless 2) 1 hourtelephone. For services of at leastof whether or not they have15 minutes duration, one unit ofpreviously received services from 3) 3 hoursservice may be billed. For eachthe clinic. Crisis Intervention –additional service increment of atComplex and Per Diem areleast 15 minutes, an additional unitMedicaid reimbursable only forof service may be billed, up to athose individuals that have beenmaximum of six units per day.seen by the clinic within theprevious two years.(2) Crisis Intervention - Complex.This requires a minimum of one hourof face-to-face contact by two ormore clinicians. Both clinicians mustbe present for the majority of theduration of the total contact. A peeradvocate, family advisor, or nonlicensed staff may substitute for oneclinician.(3) Crisis Intervention - Per Diem.This requires three hours or more offace-to-face contact by two or moreclinicians. Both clinicians must bepresent for the majority of theduration of the total contact. A peeradvocate, family advisor, or nonlicensed staff may substitute for oneclinician.NYSCRIDocumentationTemplatesOMH Standards ofCare Complex Care/CrisisIntervention/Contact Note Patient Safety PlanTemplate Relapse PreventionPlan, if indicated

NYSCRI Dashboard – Article 31 n.CPTCode96372ModifiersAvailableNote: FBmodifier isno reviated OMH Part 599Guidance. Please refer to the fullPart 599 guidance document(2015)Injectable PsychotropicMedication AdministrationDefinition: Injectable psychotropicmedication administration is theprocess of preparing, andadministering the injection ofintramuscular psychotropicmedications.Guidance: This service must beprovided by an appropriate medicalstaff person.Abbreviated Rules for billingMedicaid Fee for Service(FFS)eMed N Y billing providermanuals&OMH APG Wt. & RateThere is no time limit and nomodifiers are available.A: When medication obtainedwith cost to clinic. The clinicsubmits a claim off the Medicaidfee schedule claim (J Code ofthe drug plus CPT code 96372for the injection). Medicaid willpay for the acquisition cost of thedrug and 13.23 for Injection.–orB: When medication isobtained without cost to clinic(e.g., the client brings the drugto the clinic). The clinic will billusing the J Code for the drugwith the FB Modifier on APGclaim. The payment value is 13.23. The FB modifierindicates that the drug wasadministered but the clinic didnot pay for the oneOMH Standards ofCare Health tration/with Monitoringand EducationOthers as noted in firstrow, plus any new oradditional relevantinformation.

NYSCRI Dashboard – Article 31 n. d OMH Part 599Guidance. Please refer to the fullPart 599 guidance document(2015)Injectable Psychotropic MedicationAdministration with monitoring andeducation is the process ofpreparing, administering, managingand monitoring the injection ofintramuscular psychotropicmedications. It includes consumereducation related to the use of themedication, as necessary.Guidance: This service must beprovided by an appropriate medicalstaff person.Abbreviated Rules for billingMedicaid Fee for Service(FFS)eMed N Y billing providermanuals&OMH APG Wt. & RateThe clinic submits and APGclaim with CPT H2010. Thisprocedure now has a 15 minuteminimum and can no longer beprovided by LPN staff. Whenclaiming H2010, you cannotclaim 96372 on the fee scheduleon the same day.NYSCRIDocumentationTemplatesMinimumDurations15 minuteminimumOMH Standards ofCare Health tration/with Monitoringand Education

NYSCRI Dashboard – Article 31 ated OMH Part 599Guidance. Please refer to the fullPart 599 guidance document(2015)Definition: Psychotropic medicationtreatment means monitoring andevaluating target symptomresponse, ordering and reviewingdiagnostic studies, writingprescriptions and consumereducation as appropriate.Guidance: This service must beprovided by a psychiatrist or nursepractitioner in psychiatry (NPP). Thisservice is not intended to refer to abrief evaluation of the patient's stateor a simple dosage adjustment oflong-term medication.Psychotropic Medication Treatmentmay also result in the identificationof a need for Complex CareManagement.Abbreviated Rules for billingMedicaid Fee for Service(FFS)eMed N Y billing providermanuals&OMH APG Wt. & RateIf the clinic opts to use one of theoffice E&M codes, the code mustbe chosen based on complexity,not time. NYS Medicaid requiresthat the doctor or NPP spends aminimum of 15 minutes with therecipient regardless of the E&Mcode claimed.This service must be a minimumof 15 minutes in length in orderto be re