1 Coding, Claiming, and Documentation Questions Association of Community Human Service Agencies November 20, 2008 Norma A. Fritsche, MSN/MPA, MHC District Chief Los Angeles County, Department of Mental Health Program Support Bureau, Quality Assurance

2 MHS-Individual or Group Therapy (Procedure Codes pages 3,4 and 8; Org Manual page 2-4) Definition: Insight oriented, behavior modifying, supportive psychotherapy, interactive play therapy and/or therapy using non-verbal techniques. Definition: Insight oriented, behavior modifying, supportive psychotherapy, interactive play therapy and/or therapy using non-verbal techniques. Procedure Codes: 16 different codes, see Procedure Codes Guide Procedure Codes: 16 different codes, see Procedure Codes Guide Important to Remember: Important to Remember: Individual therapy involves only one client Individual therapy involves only one client Collaterals or agency staff may be present Collaterals or agency staff may be present Group therapy involves two or more clients Group therapy involves two or more clients Can only be used by: Can only be used by: MD/OD MD/OD RN/NP RN/NP Licensed/waivered Psychologists Licensed/waivered Psychologists Licensed/registered Social Worker & MFT Licensed/registered Social Worker & MFT

3 MHS-Individual or Group Rehab (Procedure Codes pages 5 and 8; Org Manual page 2-4) Definition: Assistance in improving, maintaining, or restoring client’s functional, daily living, social/leisure, grooming/personal hygiene, meal prep skills, support resources Definition: Assistance in improving, maintaining, or restoring client’s functional, daily living, social/leisure, grooming/personal hygiene, meal prep skills, support resources Procedure Code: H2015 Procedure Code: H2015 Important to Remember: Important to Remember: Individual Rehab involves only one client but potentially many collaterals or agency staff Individual Rehab involves only one client but potentially many collaterals or agency staff Group Rehab involves two or more clients Group Rehab involves two or more clients License is not required License is not required Assistance does NOT mean doing something for someone, but helping a person with an impairment through habilitative or re- habilitative activities learn how to perform a task s/he had previously been unable to perform due to his/her mental disability Assistance does NOT mean doing something for someone, but helping a person with an impairment through habilitative or re- habilitative activities learn how to perform a task s/he had previously been unable to perform due to his/her mental disability

4 TCM-Targeted Case Management (Procedure Codes page 10; Org Manual page 2-14) Definition: Services needed to access medical, educational, social, prevocational, vocational, rehabilitative, or other community services. These services, whether face-to-face, by phone, or through correspondence, provide for the continuity of care within the mental health system and related social service systems. Services include linkage and consultation, placement, and plan development. Definition: Services needed to access medical, educational, social, prevocational, vocational, rehabilitative, or other community services. These services, whether face-to-face, by phone, or through correspondence, provide for the continuity of care within the mental health system and related social service systems. Services include linkage and consultation, placement, and plan development. Procedure Code: T1017 Procedure Code: T1017 Important to Remember: Important to Remember: TCM is the linkage and brokerage to a service and not the provision of the service itself TCM is the linkage and brokerage to a service and not the provision of the service itself To obtain Medi-Cal reimbursement for TCM, the linkage and brokerage activities must be related to addressing the client’s mental health needs To obtain Medi-Cal reimbursement for TCM, the linkage and brokerage activities must be related to addressing the client’s mental health needs

5 Combined Services in a Single Contact such as a CFT Distinct Services should not be combined Distinct Services should not be combined If distinct services occur in one contact, each distinct service should be documented and claimed separately If distinct services occur in one contact, each distinct service should be documented and claimed separately Licensed clinician provides therapy to the client and unlicensed facilitator and CFS provide family and client interventions Licensed clinician provides therapy to the client and unlicensed facilitator and CFS provide family and client interventions Document and claim Therapy for the clinician Document and claim Therapy for the clinician Document and claim Individual Rehab for the facilitator and CFS Document and claim Individual Rehab for the facilitator and CFS During a Team Conference where interventions are directed at agency staff but client is present, the CFS has to prompt an anxious client During a Team Conference where interventions are directed at agency staff but client is present, the CFS has to prompt an anxious client Document and claim for team conference for staff participation time Document and claim for team conference for staff participation time Document and claim a separate note for the time the CFS prompted client using Individual Rehab Document and claim a separate note for the time the CFS prompted client using Individual Rehab A CFT can look like a lot of different services during a single contact A CFT can look like a lot of different services during a single contact Example 1: Facilitator checks in with client, family members, and staff during a CFT, checking in about progress and status Example 1: Facilitator checks in with client, family members, and staff during a CFT, checking in about progress and status Plan development as stand alone service Plan development as stand alone service Example 2: Facilitator directs discussion with staff, client, and family members re: progress, strategies and actions to take (i.e. baseball vs. ballet) Example 2: Facilitator directs discussion with staff, client, and family members re: progress, strategies and actions to take (i.e. baseball vs. ballet) Individual Rehab with plan development Individual Rehab with plan development