Wiki Billing Individual therapy (90804,90806) & interactive (90810, 90812) same day

[nekirkland]

Medicaid has hired an audit company to do random audits and they have recouped payments from LPCs when an interactive and individual therapy were billed and paid for the same patient on the same DOS. Every other LPC we have talked to bills the same way and continues to do so and has been paid by MCD for years. I cannot find anything stating that this is not allowable. However there are a certain number of visits per code per year allowed which is tracked by the biller/provider so we are careful in keeping up with the codes billed. The audit time frame was March 2009 to April 2010. If anyone has any valid documentation that it is not acceptable to bill interactive therapy with individual therapy by LPC's Please email link, documentation anything that will solidify this recoupment.

Sincerely,
nbowman

 

[1073358]

Medicare NCCI edits shows that as not allowable

 

[MJ4ever]

I would think that interactive and individual psychotherapy is not allowable during the same session. It's can only be one or the other.
How would it be interactive, needing tools and toys to assist and then on another session it wouldn't. That doesn't make sense to me.
Also, if the patient is seen on the same day, by the same provider, it could only create one claim and get denied.

I guess not even appealing it would be a choice if it is not allowable per the NCCI edits.

Barbara