Coding, Classification and Reimbursement

Coding H0004

  • 1.  Coding H0004

    Posted 01-08-2019 14:48
    ​​Hello
    I'm new to coding professional fee for behavioral health and have a question regarding definition of this code as it relates to the time component.  The code says "per 15 minutes" - what exactly does this mean?  If the visit is only 5 minutes, am I still able to report 1 unit of H0004?  Or, must it pass 15 minutes in order to report 1 unit?  Appreciate any insight you can share.  Thank you!

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    Lynn A. Wall, RHIT, CCS
    Interim Coding Supervisor
    Maricopa Integrated Health System
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  • 2.  RE: Coding H0004

    Posted 02-22-2019 13:11
    ​Hello all -
    Was wondering if anyone had any thoughts my question below - appreciate any help regarding the coding/reporting of H0004 - specifically round the time-based component and if it can be used for less than 15 minutes. Thanks -

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    Lynn A. Wall, RHIT, CCS
    Interim Coding Supervisor
    Maricopa Integrated Health System
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  • 3.  RE: Coding H0004

    Posted 02-22-2019 14:07
    Is the payer Medicaid?
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    Sent from Gmail Mobile Samantha





  • 4.  RE: Coding H0004

    Posted 03-08-2019 20:34

    ​Hi Lynn,
    This info isn't specifically for your question, but for HCPCS service units.


    The Medicare Claims Processing Manual, in chapter 5, outpatient rehab, has section 20 for HCPCS coding requirements. Under section 20.2, there is discussion of timed codes, counting minutes, billing units, etc.

    Be aware behavioral codes aren't included in this chapter, but this is the chapter I remembered from my auditing days. Perhaps you could review other chapters in the Claims Processing Manual for discussion of HCPCS service units. However, I would feel comfortable using these section 20.2.C "Units Number of Minutes" as guidelines.

    Hope this helps a little.

    Have a good weekend,
    ann



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    Ann Waters, RHIT, CCS
    Consultant
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