Wiki Group visits

[kellis1973]

We are a pediatric office that has LMSW's working with our patients for their behavioral issues. We are starting group visits, but have a question in regards to a coding issue. We will be using CPT 98961 & CPT 90853. Does anyone know for example: if we have a group of four patients and 3 of the four fall under 98961 and only one falls under 90853, can we still bill those codes for that group? Guidelines state 2 or more in group, we have four and all have same diagnosis and documentation will be appropriate for each code individually under each patient, but we are concerned because 3 of the 4 fall under one code and one patient falls under the other code?? Can anyone shed some light or help to see if we should do this? Appreciate the info and help. Thank you!

 

[SharonCollachi]

Okay, I'll bite. Why do they not all come under 90853?

Also, don't forget to review the interactive complexity code, 90785, particularly with children. Look at all of the criteria for that code (not all of the participants have to have the code added for one of them to have it).

 

[kellis1973]

Okay, I'll bite. Why do they not all come under 90853?

Also, don't forget to review the interactive complexity code, 90785, particularly with children. Look at all of the criteria for that code (not all of the participants have to have the code added for one of them to have it).

That's what we think they should be. She has certain patients that fall under the 98961 for care management etc. Then she has her behavioral health patients. I suggested we keep the groups uniform, because I am unsure if we could do that?

 

[SharonCollachi]

I don't think you can have one group comprised of both, because they are different things. You can have a group based on behavior management, or anger management, or grief, or whatever, but that would all be 90853.

98961 is for training people how to self-manage a disease using a standardized curriculum using guidelines or standards recognized or established by a physician society, a non-physician society/association, or similar source. The most common one is diabetes (although there is a G code for that for Medicare and some other payers), but also things like a group for people with cancer, or heart attack patients, or obesity.

 

[kellis1973]

I don't think you can have one group comprised of both, because they are different things. You can have a group based on behavior management, or anger management, or grief, or whatever, but that would all be 90853.

98961 is for training people how to self-manage a disease using a standardized curriculum using guidelines or standards recognized or established by a physician society, a non-physician society/association, or similar source. The most common one is diabetes (although there is a G code for that for Medicare and some other payers), but also things like a group for people with cancer, or heart attack patients, or obesity.

Thank you. I really appreciate your feed back.