Wiki Billing 99214, 90833 and 90868 on the same day

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Blackhorse

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We bill 99214, MOD 25; 90833; 90868, MOD 59 on the same date. Anthem only paid 90833, and denied both 99214 and 90868. This is very weird because 90833 is an add-on code, how can they pay only an add-on code and deny the primary code 99214? 90833 has to bill with an E/M code. Modifier 59 is added for 90868, it should get paid also. Is anyone familiar with mental health billing, am I missing anything here?
 
You may need to appeal with documentation: For 90868 there is this note in the CPT guidelines "(If a significant, separately identifiable evaluation and management, medication management, or psychotherapy service is performed, the appropriate E/M or psychotherapy code may be reported in addition to 90867-90869. Evaluation and management activities directly related to cortical mapping, motor threshold determination, delivery and management of TMS are not separately reported)"

Thus 90868 would be the principal code (no modifier). 99214-25 ( only if separately identifiable as above) and 90833. If the psychotherapy was not performed by the same provider as the one(s) for 90868 and 99214, use the appropriate psychotherapy code (not an add-on) under the rendering and/or appropriate provider level modifier.

A complicated scenario that will probably need a well-written letter of appeal and attached documentation.
 
ckeeney said:
You may need to appeal with documentation: For 90868 there is this note in the CPT guidelines "(If a significant, separately identifiable evaluation and management, medication management, or psychotherapy service is performed, the appropriate E/M or psychotherapy code may be reported in addition to 90867-90869. Evaluation and management activities directly related to cortical mapping, motor threshold determination, delivery and management of TMS are not separately reported)"

Thus 90868 would be the principal code (no modifier). 99214-25 ( only if separately identifiable as above) and 90833. If the psychotherapy was not performed by the same provider as the one(s) for 90868 and 99214, use the appropriate psychotherapy code (not an add-on) under the rendering and/or appropriate provider level modifier.

A complicated scenario that will probably need a well-written letter of appeal and attached documentation.
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Thank you so much (y)(y)(y)
 
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