Wiki 90791 and 90834 same day

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bkerste

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Hi all :) I'm new to BH coding & I'm looking for a little guidance. I have a claim where a 90791 and a 90834 were billed out together--Aetna paid the 90791 but denied the 90834 as included in the primary procedure. From what I've researched it looks like we should be able to bill the 2 on the same day. Am I mistaken or am I correct? If I'm correct, how should I go about my appeal?

PS I'd welcome any good resources for researching stuff like this or just about BH coding in general, TIA :)
 
bak230 said:
Hi all :) I'm new to BH coding & I'm looking for a little guidance. I have a claim where a 90791 and a 90834 were billed out together--Aetna paid the 90791 but denied the 90834 as included in the primary procedure. From what I've researched it looks like we should be able to bill the 2 on the same day. Am I mistaken or am I correct? If I'm correct, how should I go about my appeal?

PS I'd welcome any good resources for researching stuff like this or just about BH coding in general, TIA :)
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Hi there, 90834 is bundled into 90791 and it can't be unbundled according to the National Correct Coding Initiative edits. You can only bill 90791.

If Aetna uses NCCI edits that would explain the denial. A quick way to check bundling edits is to run the codes through an edit tool such as the free one offered by Medicare administrative contractors.
 
jkyles said:
Hi there, 90834 is bundled into 90791 and it can't be unbundled according to the National Correct Coding Initiative edits. You can only bill 90791.

If Aetna uses NCCI edits that would explain the denial. A quick way to check bundling edits is to run the codes through an edit tool such as the free one offered by Medicare administrative contractors.
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Perfect, thanks! What's the easiest way to find the Medicare edit program you're referring to? Would I easily be able to find it on Medicare's website or would I be better off googling it?
 
Not only the NCCI edit, but the CPT book explicitly states diagnostic assessment/reassessment and psychotherapy services can't be reported on the same day. Refer to the Psychiatric Diagnostic Procedures chapter guidelines before the listing for 90791/90792.
 
A follow up question, If a MD performed the the assessement/evualation 90791 and a LCSW performed the psychotherapy and applied a degree level modifier, this would bypass the NCCI edits and be allowable since 2 different providers rendered the services. The CPT book is not clear regarding the psychotherapy.

[...]Codes 90791, 90792 may be reported once per day and not on the same day as an evaluation and management service performed by the same individual for the same patient. [...]
Codes 90791, 90792 are used for the diagnostic assessment(s) or reassessment(s), if required, and do not include psychotherapeutic services. Psychotherapy services, including for crisis, may not be reported on the same day. [...] this statement does not include "by the same individual"
Thank you
 
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