99213 & 90832 same DOS different providers

[volleyb13]

I have a psychiatrist who is providing a E/M on the same date of service that a therapist is providing individual psychotherapy. Since the services are being provided by 2 different providers, I cannot bill as 99213 & 90833. Is it appropriate to bill as 99213 & 90832 and appeal as 2 different providers same DOS?

Any info on this situation would be wonderful. They of course denied since it is a CCI edit that 99213 & 90832 are not allowed to be billed on the same DOS, but they were by different providers.

 

[Leenahz]

I have a psychiatrist who is providing a E/M on the same date of service that a therapist is providing individual psychotherapy. Since the services are being provided by 2 different providers, I cannot bill as 99213 & 90833. Is it appropriate to bill as 99213 & 90832 and appeal as 2 different providers same DOS?

Any info on this situation would be wonderful. They of course denied since it is a CCI edit that 99213 & 90832 are not allowed to be billed on the same DOS, but they were by different providers.

I'm fairly new to behavioral health billing, but I've heard of our agency having the same issue; especially with our Medicaid/MCO clients. Our Reimbursement Manager contacted the Medicaid MCO's Billing Manager and we were advised to use a modifier 25 on the E/M charge, but (shocker), the claims were rejected. We've since done some appeals and they've been hit or miss from what I've heard. This said, when I looked into this with VA DMAS I found that therapy provided by a LCSW or LPC wasn't reimbursable with an E/M visit provided by a doctor, but a CNS was.

Blah. If you find out any other info I'd be interested to know.

Lena

 

[volleyb13]

Thank you Lena. And wow, very surprised they told you to use a 25 modifier, since that should only be used by the same physician providing both the services. I will post if I find out any additional info.

 

[LisaMiles2025]

Lcsw

I too am looking at any and all templates, documentation requirements for LCSW seeing patients in physician office. I called medicare and could not be given information as to bill incident to or with own medicare number. Any information is greatly appreciated.

 

[akandrew]

Have you tried adding modifer 59 to the psychotherapy code?

 

[Leenahz]

Have you tried adding modifer 59 to the psychotherapy code?

I'm not sure what denials have come back since my original post, but that's certainly something worth looking into.

Thanks!

 

[Leenahz]

I too am looking at any and all templates, documentation requirements for LCSW seeing patients in physician office. I called medicare and could not be given information as to bill incident to or with own medicare number. Any information is greatly appreciated.

Lisa, have you found anything? I was looking into the new XP modifier.

Lena

 

[akandrew]

When I append modifiers 25 and 59, the codes get through our edits. We frequently have 2 services on one day: 1 service with the psychiatrist for med. management and psychotherapy and the other service is a group therapy visit by another provider. So the coding would look like this:

99213-25
90833-59
90853

 

[pmueller13]

Same DOS different Providers

I am fairly new to Behavioral Health, My provider A (Psych) started a Telehealth visit at 9:45 am and then then Provider B (Medical Telehealth) stepped in and did a medical visit which took approx. 20 Min. Then Provider A completed his Visit.

Question is Can both providers bill? How does the Time factor work in the patients EMR?

TIA Patty