Service Definitions-Procedure Codes

The Department of State Health Services (DSHS) Division for Mental Health and Substance Abuse Services moved toward full compliance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996 in fiscal year 2008. During fiscal year 2008 state level service coding procedures were mapped to Current Procedural Terminology (CPT) codes and Healthcare Procedure Coding System (HCPCS) codes.

HIPAA requires that all record keeping and billing processes for medical services (which include mental health and substance services) use nationally standardized diagnostic and service codes to improve quality communications between business entities.

In an effort to allow Local Mental Health Authorities (LMHA) with time to complete changes to their own electronic health record keeping systems, this process was completed over a twelve month period. Full use of CPT and HCPCS codes was required beginning third quarter FY 2008 with encounter submissions pertaining to location, server type, etc. receiving a warning message until September 2008.

Full use of national coding procedures for all mental health and substance treatment and intervention services with accurate supporting encounter codes will be required for fiscal year 2009. Starting on September 1, 2008, all supporting codes must be accurate for an encounter to be accepted in the warehouse.

Mental Health and Substance Treatment, Prevention and Intervention Service are defined in the program attachments of the performance contract. Procedure code specific service definitions can be found within consumer analysis detail reports in the Mental Retardation and Behavioral Health Outpatient Warehouse (MBOW). Below are instructions that show how to access these consumer analysis detail reports, which were designed to assist LMHAs with the transition from service grid codes to procedure codes:

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Last updated September 1, 2010