Question Billing for EMDR

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Has anyone had success with ANY payers when billing for EMDR services? Currently, one of our LPC's provides EMDR and we bill this as a 90837+90899. We've received denials from several payers for CO-16 (Claim/service lacks information which is needed for adjudication.), N350 (Missing/incomplete/invalid description of service for a Not Otherwise Classified (NOC) code or for an Unlisted/By Report procedure.)

We have sent additional documentation supporting all of these services, but continue to receive denials.

Any suggestions on submitting a claim for EMDR with successful payment? If so, how was it coded and to which payer was it submitted?

Thanks for any help!
 
Hi Jnk:)
I d get it preapproved by first for EMDR for at least 6 to 8 sessions. The LCSW or LPC must document what type of pt trauma they had, then discuss it and then describe eye movement in documentation after 3 or 4 session. However CPT 90834-90837 are covered but NOT 90899 unlisted at all. Most payers will not cover unlisted CPT. If it is prolonged service CPT 99354- 99357 therapist needs to add that in documentation and amount of time if over an hour for face to face . Dx to bill are eventually PTSD, but last dx Z86.51 if supported stressed due to military.. Look at dx blocks of R45 with F34 too as symptoms but use dx which start with dx F06, F08 .Check out Z codes of blocks of Z63 to Z65 & Z73 last dx but must be in documentation. Also get therapist to put dates associated with and past hospitalization if linked to PTSD problem.

EXCLUSIONS, not all-inclusive but can be deniable. Some payers considers EMDR therapy experimental and investigational for all other indications because its effectiveness for indications other than PTSD has not been established and therefore Not Covered:  Pre-Prevention of PTSD  Addiction/Substance abuse disorders  Personality disorder  Psychiatric and behavioral disorders such as: anger, bipolar disorder, de-personalization de-realization disorder, o depression, o dissociative disorders, o eating disorders, o guilt, o obsessive-compulsive disorder, o phobias, o psychogenic non-epileptic seizures, o psychotic disorders, o schizophrenia, and o somatoform disorders.  Autism spectrum disorders  Dissociative disorders  Anxiety disorders such as: o panic disorder, o claustrophobia, o blood and injection phobias, o spider phobias, o dental phobia and o social phobia (other than PTSD)  Chronic pain including: o chronic back pain, o chronic phantom limb pain and o rheumatoid arthritis  Methotrexate intolerance  Post-operative pain  Treatment of tinnitus

Good Luck !(y)
Lady T
 
Has anyone had success with ANY payers when billing for EMDR services? Currently, one of our LPC's provides EMDR and we bill this as a 90837+90899. We've received denials from several payers for CO-16 (Claim/service lacks information which is needed for adjudication.), N350 (Missing/incomplete/invalid description of service for a Not Otherwise Classified (NOC) code or for an Unlisted/By Report procedure.)

We have sent additional documentation supporting all of these services, but continue to receive denials.

Any suggestions on submitting a claim for EMDR with successful payment? If so, how was it coded and to which payer was it submitted?

Thanks for any help!
EMDR is therapy; however 90837 requires preauth in most cases. Unsure why adding the 90899
 
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