90791 and E/M same day

CodingKing

True Blue
Messages
3,955
Best answers
1
Since its a different specialty bill on 2 separate claim forms. One for the MD ( I assume they are handling the meds management part?) and one for the LICSW (I assume they are handling the counseling aspect)
 

Tarheelcoder

Networker
Messages
26
Best answers
0
CodingKing,

Thanks for your reply.

We already do send the claims out on separate claim forms but our Medicaid MCO's have suddenly started denying. They are paying the 90791 and saying the E/M code is concurrent. In the 2016 CPT book it states: 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.

I thought since the 2 services were provided by 2 different providers it would be payable.
 

CodingKing

True Blue
Messages
3,955
Best answers
1
CodingKing,

Thanks for your reply.

We already do send the claims out on separate claim forms but our Medicaid MCO's have suddenly started denying. They are paying the 90791 and saying the E/M code is concurrent. In the 2016 CPT book it states: 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.

I thought since the 2 services were provided by 2 different providers it would be payable.
Some payers like to make up their own rules stricter than AMA's CPT Guidelines. Maybe check with Medicaid to see if they can point to a policy?
 

mitchellde

True Blue
Messages
13,538
Location
Columbia, MO
Best answers
2
Does the LCSW have their own NPI and are they credentialed with the payer as a provider. If not then they will bundle the services together and there will be no way to appeal it. If they are separately credentialed with an NPI the which NPI did you use in field 24J?
 

Tarheelcoder

Networker
Messages
26
Best answers
0
The LCSW does have their own NPI and is credentialed with the payer. The LCSW's NPI is linked to her service in 24J. The MD performed his E/M and his claim was sent out on a separate claim form with his NPI in 24J. The MCO's are saying they have put NCCI edits in place that just started and these two can't be billed on the same day.
 
Top