Wiki E\M vs Psychotherapy (90837)

[01503628]

Hi all,

We have a Psych office with a situation we are not sure they can bill for or not.

Dr. John is an MD
Diana is a MALLP (psychologist)

For example, John bills a 99214 and Diana bills a 90837

They are billing the same patient on the same date of service. The office believes they should be getting paid for both using a modifier but we are getting all of John’s rejected.

Do you know if an MD and MALLP can bill the same patient on the same day?

 

[erjones147]

They should be separately billable. The only thing I can think of is that the insurance company is checking the taxonomies and blocking it that way. Is it every visit? Certain payers? What is/are the denial reasons on the OV code for the psychiatrist?

 

[unicorn80]

Hi all,

We have a Psych office with a situation we are not sure they can bill for or not.

Dr. John is an MD
Diana is a MALLP (psychologist)

For example, John bills a 99214 and Diana bills a 90837

They are billing the same patient on the same date of service. The office believes they should be getting paid for both using a modifier but we are getting all of John’s rejected.

Do you know if an MD and MALLP can bill the same patient on the same day?

I don't think you can code a 90837 with an E/M service on one claim when performed on same date of service. They should be billed separate because they are two different providers that saw the patient. If it were just the one doctor that saw the patient and performed the psychotherapy evaluation then it would be fine. If you are still not sure what to do I would consult with the insurance this is being billed to. They may have specific guidelines with the use of these codes when there are two providers involved in the patients care.

 

[01503628]

Thank you all