Billing for Co-Occurring Disorders in Intensive Outpatient Programs

Intensive outpatient programs, or IOPs, are becoming more popular as a therapy option to hospitalization or other inpatient therapies for persons who do not require detoxification. IOPs are often offered to patients with substance abuse orders who have either completed or do not require a detoxification period and to persons with specific types of eating disorders or depression who are not in danger of self-harm. The patient benefits from retaining a presence at school or a job, reduced expenses, and the opportunity to live at home. Discover effective billing strategies for co-occurring disorders in intensive outpatient programs.

An IOP is a series of multiples on the provider side:

  • Multiple treatment services (family, individual, and group therapy) and
  • Treatment modalities (rational emotive behavioral therapy and cognitive behavioral therapy),

delivered on multiple days per week (usually a minimum of three) and delivered by a multidisciplinary team of mental health specialists, which may include psychologists, psychiatrists, clinical social workers, and counselors. Most programs must provide at least three hours of psychiatric and therapeutic treatments per day, including at least two group therapy sessions and individual services to address mental health concerns.

Let’s have a deep dive into the billing for co-occurring disorders in intensive outpatient programs:

Intensive Outpatient Programs (IOPs) Billing Guidelines:

  • Prior authorization

Many insurance companies need prior authorization or approval before covering IOP services. To avoid claims rejection, keep an eye on expiration dates and submit new authorization requests if necessary before the original expires.

  • Service duplication

Billing two IOP service units for the same patient on the same day is usually considered a duplication of services. For example, if a patient is treated in a substance abuse IOP and a mental health IOP, you should submit that information to the insurance company individually but do not anticipate billing IOP sessions twice. Most insurers require you to combine care in an individual plan and bill for a single IOP service in this situation.

  • Physicians’ services

Physician service fees are included in the program rate if IOP care is administered in an outpatient mental health center. Physician services are usually reimbursed separately if the IOP is provided at a hospital.

  • Service duration

While carrier guidelines and state licensing laws differ, an IOP is typically a short-term, acute intervention that should last no more than 90 to 180 days. Even though an IOP can theoretically only deliver two hours of services per day, most private payers require 180 minutes of active therapy per day to reimburse per diem fees. As a result, clinical documentation supporting the entire 180 minutes of treatment is critical.

Intensive Outpatient Programs (IOPs) Coding Rules:

The IOP billing codes will differ depending on whether the services are primarily for substance abuse or mental health issues. It’s crucial to understand that if a patient has a dual diagnosis of substance abuse and mental disorders, you can only bill for one IOP session per day, even if both issues are treated in the session. You may document such information for the payer, but except in minimal instances, duplicate billing claims will usually be disallowed.

In general, you will use one of two basic HCPCS codes for IOP services depending on whether the diagnosis code is for alcohol and substance abuse treatment or mental health.

  • Alcohol and other substance abuse IOPs

The HCPCS 2016 code is H0015, and it states that Alcohol and/or drug services, intensive outpatient (treatment program which works at least 3 hours/day and at least three days/week and depends on an individualized treatment plan), including counseling, assessment; crisis intervention, and activity therapies or education. It is important to note that one service unit represents three hours of treatment in a single day, and clinical documentation is frequently required. In most circumstances, the four-digit revenue number 0906 will be used for intensive outpatient services for chemical dependency.

  • Mental health IOPs

For mental health IOP sessions, the HCPCS 2016 code is S9480, defined as “Intensive outpatient psychiatric services, per diem.” The revenue code 0905 for intensive outpatient psychiatric services is acceptable for this service.

Most payers regard these IOP services to be an inherent element of the per diem rate and cannot be billed separately in addition to the HCPCS codes listed above:

  • Supplies
  • Diagnostic and evaluative testing, including neuropsychological testing
  • Ancillary services
  • Medication management
  • Drug and alcohol tests performed at laboratories
  • Individual, group, and family therapy sessions
  • Crisis intervention

Outsourcing IOPs Billing & Coding:

Is your intensive outpatient program (IOP) encountering frequent reimbursement delays or denials? You might be dealing with reimbursement issues and trying to solve them through complicated processes that frequently waste resources while delivering little or no remedy.

While reimbursement delays and denials are typical in your facilities, minor changes to your IOP billing KD30 can help speed up the process. Improving your billing process lowers delays and denials while ensuring revenue is not lost due to uncaptured items. But what exactly is required for smooth IOP billing and coding?

The optimal solution is outsourcing IOP billing and coding tasks to 24/7 Medical Billing Services.

You can smoothly streamline your entire process with the assistance of these experts. In fact, your in-house billers and coders will no longer need to memorize different IOP codes after you outsource your IOP billing and coding.

See also: The Technology Revolution: Innovations In Medical Billing Outsourcing


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