• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Anthem questioning use of 90837

B

bridgettemartin

Expert
Messages
282
Location
Pensacola, FL
We have a PsyD that received a payer letter indicating they are billing a higher number of 60 minute therapy visits (90837) than their peers. We do Bell Curves and benchmarking, but do not have access to benchmarking tools for Psychotherapy codes.

Therapy codes are time based. If they provide 60 minutes, you bill the 60 minute code. I'm a little confused as to why a payer would question that.

Wondering if anyone might be able to provide some insight.
 
It may be diagnosis driven as well.. I would see what exactly the provider is documenting and for what diagnosis. The question is not always how much time you spent, but given the diagnosis should that have been the case.
 
Thanks for the feedback. I hadn't thought of that for this scenario.

If that is the case, I wonder how the payer determines which codes support 60 minute visits. Especially when the Provider states the time is justified.
 
You must log in or register to reply here.
Top