Wiki 90849 Interchangable with S5111

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amanda.vanhouten85@gmail.com

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There is a debate going on in my office that codes 90849 and S5111 can be interchangeable. Some insurance carriers will not pay for S5111 so my office wants to bill out a 90849 in replacement of that code. I do understand that S5111's definition is Home care training, family; per session and that 90849's definition is Multiple-family group psychotherapy. We are providing the services to multiple families, but the services are performed in the office. To my understanding S5111 can only be used if the services are provided in the home. Could someone please clarify with me if this is true?
 
Because an insurance company won't pay for a code, doesn't mean it isn't the correct code. Just using a different code to get paid can get you in a whole lot of hot water. I don't personally bill for S5111, so I don't know a lot about it. But I do know that Medicare doesn't and never has reimbursed for it. That doesn't mean that isn't the code you use. Just like CPT codes that are considered "experimental" ... you still use that CPT and and have to know you aren't going to get paid.
 
These codes don't sound like they are the same thing. Home care training and group psychotherapy? What kind of discussion is going on in these sessions?
 
I wonder what code they would be debating if it were just an individual psychotherapy visit? DBT is just one of many types of psychotherapy.

The S code is as expected looks to be more related to home health and not office care
 
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