An Update on Billing and Coding for the Psychiatric-Mental Health Nurse Practitioner

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. By clicking below on the button labeled “I accept”, you hereby acknowledge that you have read, understood and agreed to all terms and conditions set forth in this agreement. When payers speak with you, they’ll give every conversation a reference ID and indicate the representative with whom you’ve spoken. You should do the same – just ask your contact for the reference ID and their name. This way, if you have to contact the payer again (and you almost certainly will), you’ll have a traceable record of all billing steps you’ve taken to date.

• They would need to research the requirements needed to be an effective business and draw up financial plans.
• You, your employees and agents are authorized to use CPT only as agreed upon with the AMA internally within your organization within the United States for the sole use by yourself, employees and agents.
• It is expected that current master’s-prepared nurses will be “grandfathered’ into the new system and as long as they keep their certification current, they will not be required to pursue a doctoral degree.
• If you have had issues with incorrect information in the past leading to claims issues, it’s always best to implement double-checking in your practice.
• When these services are billed to health insurance, it is often a simple task because routine checkups are frequently under one general charge.

Now that you know how ICD codes are relevant to insurance billing, CPT codes have a similar role. ICD codes are used primarily for diagnosing a patient, whereas CPT codes are used to support the diagnosis with the necessary medical treatment. As with any mental and behavioral health industry procedure, it doesn’t hurt to double-check yourself. If you have had issues with incorrect information in the past leading to claims issues, it’s always best to implement double-checking in your practice. Confirming your patient’s insurance is one of these areas where you want to be certain.

Submit Claims Properly

Social services settings that employ PMHNPs include agencies, schools, prisons, public health clinics, and shelters. The U.S. Bureau of Labor Statistics (BLS) reports median annual earnings of $117,670 for all APRNs, including PMHNPs. Depending on the state, NPs may either require collaboration with a physician or they may be able to practice independently without collaboration.

The certification was formerly known as the Family Psychiatric-Mental Health Nurse Practitioner but now includes patients across the lifespan. Therefore, the patient population that a PMHNP works with could include children, adolescents, adults and the elderly. Notably, the work setting of a PMHNP will likely influence the patient population that a PMHNP sees on a daily basis, and many PMHNPs work in private practice or hospital settings.

How do I find out if a specific CPT code is covered in my state?

They may also work with social workers, clergy, and other partners who contribute to healthcare but are not healthcare workers themselves. NurseJournal.org is committed to delivering content that is objective mental health billing and actionable. To that end, we have built a network of industry professionals across higher education to review our content and ensure we are providing the most helpful information to our readers.

Noncommercial use of original content on is granted to AHA Institutional Members, their employees and State, Regional and Metro Hospital Associations unless otherwise indicated. Students with a bachelor’s in a non-nursing field may pursue an accelerated BSN program that allows them to complete all their undergraduate nursing requirements in 18 months or less. However, this list is likely to grow as more states consider legislation to expand NP authority. Integrity Network members typically work full time in their industry profession and review content for NurseJournal.org as a side project. All Integrity Network members are paid members of the Red Ventures Education Integrity Network.

Engage, Learn, Network and Progress Practice in Psych and Mental Health

The billing process can be frustrating and generally a big sigh compared to treating patients; however, the sooner you start, the sooner you get paid. And if you’re worried you can’t complete the process solo, the billing features of medical practice management systems (PMS) or third-party medical billing services can provide invaluable help. Once you’re familiar with the ICD-10, CPT, E/M and psychiatric evaluation codes relevant to your services, you can formally begin the billing process. The first step is to conduct a verification of benefits (VOB) for each patient before their first visit. Then, log in to the insurer’s provider portal and determine whether the patient’s insurance covers your services. However, regardless of the services you provide, it’s always a good idea to check that your patient is covered for the mental health services they need.

They may also work in disaster relief or similar humanitarian care settings. You’ll need to earn either an ADN or a BSN from an accredited nursing program in order to take the first steps to becoming a registered nurse. ADN-prepared nurses will need to complete an additional step of either completing their BSN degree or entering into an accelerated RN to MSN program which will let them earn their BSN and MSN at the same time. However, the BLS does not differentiate between different types of Nurse Practitioners. But, according to Indeed, the average psychiatric nurse practitioner salary is $139,261.

Why Is Mental Health Billing So Complicated?

Before sessions with any new or existing patient, ensure that you know their insurance plan and benefits ahead of time. Certifications, administered by national certifying boards such as the ANCC, help nurses to broaden their career prospects and marketability. ANCC offers several NP certifications including one in psychiatric mental health nursing. PMHNPs may renew this credential after five years by maintaining their state license and meeting continuing education for nurses and other renewal requirements. You must earn a two-year ADN and pass the NCLEX-RN exam to earn an RN license. A BSN degree takes four years, but is often more valuable for career advancement.

Try entering any of this type of information provided in your denial letter. Please review and accept the agreements in order to view Medicare Coverage documents, which may include licensed information and codes. Interactive Complexity (90785) is an add-on code specific for psychiatric services and refers to communication difficulties during the psychiatric procedure.

Additionally, they must complete a minimum of 2,000 hours of pediatric behavioral, mental health, and developmental experience within five years. Thirty hours of continuing education is required or one graduate-level course that is worth two or more credits. In reduced practice states, nurse practitioners can perform some of their scope of practice without physician supervision. These restrictions https://www.bookstime.com/blog/accounts-receivable-outsourcing typically involve operating their own practices or prescribing certain types of medications. They rarely involve the nurse practitioner’s ability to order tests or diagnose conditions. For example, a nurse practitioner might need to be part of a practice that is supervised by a physician, rather than running their own practice, but within that practice, can operate with relative autonomy.