(Links to examples of progress notes have been moved to the Home Page.)
90899-1 (Case Management): Services that help link the client with medical, social, vocational, and educational providers, or other programs that are capable of providing services that address needs identified in the Care Plan. Documentation should explain why clients are unable to access these resources on their own as a result of their mental illness. This code is also used for monitoring member's progress, for consultations with persons outside our agency, and with persons inside our agency if the consultation results in a change to the TCP or a change to the course of treatment as documented in the progress note. For examples, use the link on the Home Page.
Basic idea here is, you're doing something for clients because their mental illness prevents them from doing it themselves.
Words and phrases commonly used in 90899-1 notes: Facilitated linkage between (or with); assisted client in accessing needed Medi-Cal services by; assisted client in accessing vocational resources by; monitored progress towards; helped client access educational resources by; coordinated linkage to; facilitated maintenance of current housing situation by consulting with; coordinated placement services by contacting; monitored adjustment to; assisted client in accessing necessary medical services by; helped clt access transportation resources by filling out….
Common 90899-1 Errors:
1. Mixing in "therapeutic" language. Using terms associated with therapeutic or rehabilitative services such as coached, modeled, and educated will likely result in a blended note that gets kicked back to you. Blended notes combine 2 or more services that are billed at different rates into a single note, making it impossible to bill for them correctly.
2. Using the word "linked" to describe transportation. Linkage is a skilled service in which you use your knowledge to connect clients with resources. It's not the same as transportation.
90899-5 (Case Management, Non-Billable):
- Home, field, or site visits when client isn't home or can't be found.
- CMS provided while the client is in jail, IMD, or hospital.*
- Wait time associated with billable linkage services.
- Travel & transportation when no billable service is provided.
- Making copies, sending faxes, filing paperwork, and scheduling appointments.
- Attempts to reach the client by phone and leaving messages.
- Completing a discharge/transfer summary.
- Reviewing charts prior to completing discharge/transfer summary.
- Helping a client move.
- Translating for clients because of their limited English skills.
- Completing forms for clients because they can't read or write.
- Picking up and delivering meds.
- CMS that focuses exclusively or primarily on substance abuse.
- Med escort (going to/from hospital after ambulance has taken client following 5150).
- Completing internal paperwork such as IRPs when our agency is the client's rep payee.
- Routine case consultations and treatment team meetings.
- Reporting suspected abuse to CPS or APS.
* An exception to this rule is if you're providing placement services within 30 days of a client's release or discharge. In these cases you can bill 90899-1.
90899-106 (Case Management, Non-Compliant): Case management services performed when the chart is non-compliant, or when documented 14 or more days after the date of service.
90899-17 (Rehab): These are services designed to restore, maintain, or teach clients skills that will help reduce problematic behaviors and impairments, and improve their level of functioning. For examples, use the link on the Home Page.
Basic idea here is, the client is learning something from you that they can apply to future situations, when you're not around.
Words and phrases commonly used in 90899-17 notes: Used prompts; provided feedback; engaged in skill-building; used reminders and redirection; provided coaching; helped client identifying precursors to; modeled appropriate behavior; helped client modify behavior by; reframed situation as an opportunity to; normalized client’s experience by; engaged in reflective listening; actively listened; helped client practice de-escalation techniques; role modeled; practiced; rehearsed; worked with client to identify strengths; helped client search for patterns in his behavior; developed a plan for dealing with; worked to increase client’s awareness of; developed more effective coping strategies for....
Note: Using an accepted therapeutic technique does not, in itself, cause an interaction to become billable. "Active listening," for example, may or may not be a billable service – it depends on why it’s used and how it contributes to resolving impairments identified in the recovery plan.
90899-150 (Rehab, Non-Billable): These are rehab-type services that aren’t billable because 1) the client is in a hospital, jail, or IMD; 2) the service focuses exclusively or primarily on substance abuse; 3) the service focuses on impairments related to a non-included diagnosis such as Antisocial Personality Disorder; 4) the service addresses symptoms or impairments that aren’t identified in Care Plan.
90899-161 (Rehab, Non-Compliant): Rehab services performed when the chart is non-compliant, or when documented 14 or more days after the date of service.
90899-6 (Assessment): This code is used when documenting the creation, development, and updating of TCPs. It’s also used for the assessment we do as part of the enrollment process.
90899-13 (Assessment, Non-Billable): As of 9/2/14, we can no longer bill for reviewing a client’s chart in preparation for completing a TCP. If the time you spend reviewing Caminar notes or the client's chart exceeds 2 minutes, break it out in a separate note and drop it under this code. This is also the code to use when you're working on a TCP with a client who's in a non-billable location, like a hospital or crisis residential center.
90899-110 (Assessment, Non-Compliant): Assessment note (usually a TCP note) dropped 14 or more days after you performed the service.
(Assessment services aren't affected by the status of the chart. They're only "non-compliant" if entered into Caminar late.)
90899 (Crisis Intervention): A crisis is an unplanned situation or event that is believed to present an imminent threat to the client or others. The code 90899 is used to account for time you spend intervening, assessing, and resolving a crisis. This includes assessing the client, attempting to de-escalate him or her, and if necessary, calling 911, ambulance services, ETS, and hospitals to look for a bed. These are all activities that may be necessary to resolve a crisis. Although some of these activities may appear to be "linkage," when they occur within the context of a crisis they're billed as 90899. When you put a client on a hold, in most cases you'll continue to bill 90899 until the ambulance arrives. At that point your crisis intervention services must end. If you're required to do med escort, you'll drop that as a separate 90899-5 note.
Not all crises end with the client being placed on a hold. In some cases the client won't meet criteria, and in others the crisis can be resolved through the use of therapeutic techniques. Examples of how all of these situations are documented can be accessed through the link on the Home Page.
90899-14 (Crisis Intervention, Non-Billable): Crisis Intervention performed in a non-billable location, like the hospital or a crisis residential center.
90899-107 (Crisis Intervention, Non-Compliant): Crisis Intervention note dropped more 14 or more days after you performed the service.
(Crisis Intervention services aren't affected by the status of the chart. They're only "non-compliant" if entered into Caminar late.)
"A situation was described to me that sounded like a crisis, but when I arrived on-scene there was no crisis. What service code do I use?" If an out-of-office situation is presented to you as a crisis but you find the situation not to be a crisis upon arrival, the service can still be claimed as crisis intervention if the crisis described in the originating call is so documented (i.e., "R&B manager called and reported that client had locked herself in her room and threatened to kill herself"). Billing under 90899 must end, however, as soon as you determine the initial report to be inaccurate, or the crisis to have resolved itself prior to your arrival.
Travel & Transportation: Distinguishing travel from transportation and learning how to accurately account for them is one of the most challenging tasks you'll encounter in terms of documentation. Click on "Travel Time" and "Services in the Car" on the home page, to see examples of how travel and transportation are documented in a variety of different situations.
Non-Billable & Non-Compliant Codes: Some of these are listed above. Use them when providing services to clients whose charts are out of compliance, or when clients are in "non-billable" locations such as jails, hospitals, or crisis residential centers. "NBTT" stands for non-billable travel time. These codes are used when transportation (always a non-billable service) is accounted for on a billable note. For example, if you transport a client from their home to the DMV, provide a billable linkage service there, then transport them back home, the codes used would be 90899-1 and 90899-112. Including 2 codes on one note may or may not be possible, depending on how your agency's EHR is set up.
Some activities shouldn’t be documented at all: The client should be the primary beneficiary or focus of the services we document in Caminar. When the focus shifts to ourselves or our program, we no longer document. Activities such as auditing charts, attending trainings, using the internet to educate ourselves about a client’s condition, preparing materials for groups, updating Caminar domains, fixing errors in clients' charts, etc. – these should not be accounted for in progress notes. Talk to your supervisor; in some cases you may be able to use the “Time Card” feature in Caminar to capture this time, although it won't add directly to your productivity.
Use of Abbreviations: The abbreviations you use in progress notes must 1) be on the County's list of Approved Abbreviations, or 2) be spelled out in the note. When using an abbreviation that's not on the list, spell it out the first time it appears in your note, then follow it immediately with the abbreviation, like this: "Contacted Ramon's social worker to ask about his Cash Assistance Program for Immigrants (CAPI) application. Ramon recalls completing the CAPI application last year but can't remember where." You only need to spell out the abbreviation out the first time it appears in the note -- after than you can use it freely.
Correcting Errors: When you make a mistake in a progress note, in most cases the best solution is just to correct the note in Caminar and reprint it. But in some cases this may not be practical or permissible (e.g., you find a content error in a note you wrote 14 or more days ago). The procedure for correcting errors in these situations is as follows:
- Don't use white-out. A reviewer should be able to discern the original numbers or text.
- Make a single line through the item you wish to remove or correct.
- Write "error" next to the correction (or "addendum" if material is being added).
- Initial and date the correction or addition.