Behavioral Health Billing on the Finalize Template
The Finalize template calculates the Evaluation and Management (E&M) code and submits the code to the NextGen® Enterprise PM application.
The Evaluation and Management Coding panel on the Finalize template calculates the E&M code based on the elements documented or the amount of time documented when more than 50% of the visit is spent counseling and/or coordinating care. The system fills the Visit Code field with the suggested Current Procedural Terminology (CPT) codes. You should review the suggested CPT code prior to submitting the code for billing.
When the practice selects the 97 Coding Guidelines option on the Practice Configuration practice template and the specialty is set to Behavioral Health, the system defaults to the '97 Single System Psychiatric exam guidelines for the following visit types:
- Family Consultation
- General Medical Exam
- Hospital Consult
- Medication Management without Psychotherapy
- Onsite Consult
- Psychotherapy - Individual with E&M
- Medication Management with Psychotherapy
- Medication Management with Psychotherapy and Translator
Sometimes the code cannot be calculated because there is a large range of possible codes for that visit type, multiple codes are required, or the visit type is based on time. In these cases, an alert fires stating that the code must be entered from the Additional behavioral health codes link or directly into the Procedures module. For more information on how to configure the Evaluation and Management Guidelines for your practice, go to NextGen Healthcare Success Community, and download the latest Practice Configuration Template User Guide for NextGen® Adaptive Content Engine and E&M Bullets and Field Mapping System Template for NextGen® Adaptive Content Engine.