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Wiki Billing 90837 with 97110

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laurenmowens@yahoo.com

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Hello! I appreciate any help on the following mental health codes. If an OT therapist is present during a psychotherapy session with a licensed therapist to provide support during the session, can the 55 min session be billed as a 90837 and 97110x3 with a modifier 51?
 
I work for an insurance company in Payment Integrity which conducts audits of claims. From my audit perspective, I would question billing 97110 "Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility" for a patient undergoing psychotherapy during the exact same time as a psychotherapy visit.

How does this even work, does the patient do the therapeutic exercises while talking to the mental health therapist?

This would set off red flags for our auditors because you have two timed modalities, psychotherapy and therapeutic exercises, at the same time for a single patient.
 
CBLENNIE said:
I work for an insurance company in Payment Integrity which conducts audits of claims. From my audit perspective, I would question billing 97110 "Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility" for a patient undergoing psychotherapy during the exact same time as a psychotherapy visit.

How does this even work, does the patient do the therapeutic exercises while talking to the mental health therapist?

This would set off red flags for our auditors because you have two timed modalities, psychotherapy and therapeutic exercises, at the same time for a single patient.
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Thank you for your response! I understand that it does sound odd. The provider is thinking of the benefits for our children with ADHD to allow them to move during their therapy session in therapeutic ways to help the progression of the therapy session. It sounds like one should come directly before or after the other, if that's the appropriate way for both provider services to be covered by insurance.
 
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