Wiki 90805/90807/90809

[j.troyer]

I work for a large out patient mental health agency, we have Psychiatrists, Clinical Nurse Specialists, Psychologists, Clinical Social Workers and Professional Clinical Counselors. On occaision, a client will see either an MD or a CNS for med management, and then have therapy with a PhD, SW or PCC - insurance wants this to be coded as a 90805, 90807 or 90809, but if it is two different providers, how do you do this?

In the past, we were funded as a community mental health agency, but now are doing insurance billing. The Board that we got our funds from used HCPCs codes only, so we are learning a new way of doing things.

 

[kevbshields]

Perhaps the payers are considering the counseling incident to the prescribing provider services. How did you come by the preferred coding for this? Insurance companies cannot tell you how to code, that is a conflict of interest. However, I also know they can have specifications on certain topics that violate traditional coding guidelines.

I would reach out more to understand their logic and make sure you have that in writing. If your dates of service are the same, then that might explain the logic. I would presume this to be a single payer . . . ?