Wiki 99214 and 90832

[esalcedo7151]

Good afternoon,
We billed out
*99214 MOD 25 POS 02
*90832 POS 11
different providers, they initially paid for therapy but know they are coming back to recoup due to "Service not payable with other service rendered on the same date." Was I suppose to add MOD 59 on the therapy?

 

[jkyles]

Hi there, if both providers are of the same specialty and your payer uses National Correct Coding Initiative edits you're only going to get paid for the psychotherapy service. The E/M visit is bundled into it and you can't use a modifier to break the edit.

 

[sls314]

Good afternoon,
We billed out
*99214 MOD 25 POS 02
*90832 POS 11
different providers, they initially paid for therapy but know they are coming back to recoup due to "Service not payable with other service rendered on the same date." Was I suppose to add MOD 59 on the therapy?

You can't bill 90832 and an E/M code unbundled. Most likely, you need to be billing 90833 (Psychotherapy, 30 minutes with patient when performed with an evaluation and management service). If the documentation supports it, of course.

Description for 90832 and 90833 from EncoderPro:

Report 90832 for one half hour of face-to-face time spent with the patient without an additional evaluation and management (E/M) service. Report 90833 if a separate E/M service is performed during the same encounter as the 30 minutes of psychotherapy.

 

[ckeeney]

We bill both services on the same day when one provider is a psychiatrist or NP for the 99214 and the therapy 90832 bills under the therapist (HSPP, LCSW or similar). No 25 or 59 modifiers and separate claims. Our state Medicaid also allows us to bill the therapy under the supervising psychiatrist with modifier AJ/HE if appropriate. We always use separate claims and generally do not have denials. Every once in a while we need to also append the XP modifier for "separate practitioner". This is for the rendering provider. Our billing provider is our entity and is the same on both claims. Are you billing on 1500's or UB's? On UB's it is different.

 

[esalcedo7151]

thank you all

 

[esalcedo7151]

We bill both services on the same day when one provider is a psychiatrist or NP for the 99214 and the therapy 90832 bills under the therapist (HSPP, LCSW or similar). No 25 or 59 modifiers and separate claims. Our state Medicaid also allows us to bill the therapy under the supervising psychiatrist with modifier AJ/HE if appropriate. We always use separate claims and generally do not have denials. Every once in a while we need to also append the XP modifier for "separate practitioner". This is for the rendering provider. Our billing provider is our entity and is the same on both claims. Are you billing on 1500's or UB's? On UB's it is different.

we are billing on 1500's