Wiki Individual Psychoherapy (60 min) reporting

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baffman81

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My friend, an LPC working in mental health, told me he really only uses 2 billing codes—90834 Individual Psychotherapy (45 minutes) & 90847 Family Psychotherapy (45 Minutes). He's tried to use 90837 Individual Psychotherapy (60 minutes) because that’s the time he actually gives people, but those claims have been rejected at times, he says, "as that is reserved for doctoral level therapy. When I went to resubmit a corrected claim, it was rejected, due to being a duplicate date! Argh!"

In the CPT book, the description for 90837 does not say anything about, "doctoral level therapy." How could I code and bill for 60 minutes of individual psychotherapy?

It seems like an LPC willing to commit extra time to increasing people's mental health should be able to bill for the full appointment.
 
Hi!
Are the claims being rejected or denied? Rejected claims are claims being rejected on the front end, meaning the payer hasn't even excepted the claim and its being rejected due to some reason other then the codes. If the claim is being denied, have you tried to submit the claim as a correction? I have an LPC and he uses 90837 for his patient's and I bill it with no problems.

Thanks
 
Many payers will not allow 60 min code by masters level counselor. You may want to check the contract or fee schedule.

What Cavalier40 says matches what i found on a quick google search. PA must be obtained before the appointment for 60 min visit for United.
 
Preauthorization

Interesting that you should mention the part about 90837 being used for, "doctoral," level therapy. That's precisely what the insurance company told the provider. But how can the insurance company deny payment on that basis when the description in the CPT book says nothing like that? The CPT book reads...

"90837 Psychotherapy, 60 minutes, with patient and/or family member"

It would be one thing if the payer read the claim and said, Now, hang on a minute, the contract doesn't cover those codes. But if the payer can just make up stuff not in the CPT book and then deny a claim on that basis, then what...?

Baffman
 
90837 and must be a Master Level or Certified LCSW or a Licensed Clinical Psychologist.

Authorization must be obtained for all commercial and or MCO.

Hope that helps
 
Individual Psychotherapy (60) min

I work for a psychologist office and I have run into this issue with some insurance companies. The code 90837 is often times considered "non-routine" but if you bill as 90834 it is considered routine in which will not require prior authorization and be covered.
 
Please help with therapy session allowed time length coding-

I am new to the coding psych world and as I familiarize myself with the E/M codes vs actually therapy coding timed sessions, individual vs group- I am coming to a fork in the road. May I ask your assistance please? My provider wants to investigate prolonged therapy coding as he is wanting to see patients for more than ( and is needing to) up to 90 min sessions. He has been coding with 90874 primarily with family issues mostly. To my gathering I am not seeing any type of way to code for 90 minuets using prolonged therapy as in the CPT and Desk reference it clearly states to "do not over use" prolonged therapy codes. My provider than asked about billing with add on codes? (are they only to be added to E/M codes for the first evaluation or can we use them constantly) ie; +99415, and +99416?? is this possible? similarly, wanting to know about multiple unit coding? for example: 90874 x1.5 units? would this be advisable? and finally last topic we are trying to get under way is the "interactive complexity" coding (primarily one main reason for prolonged therapy due to complex issues outside the therapy session in or at home that makes therapy more complex) what are the rules and guidelines to coding for such complications as this is their main focus type of patients. My provider also understands each payer has their own guidelines and suggested he needs to call each insurance carrier and find out what their acceptance is for this type of coding..I would love your advice, suggestions and or method if you are not too busy :) much appreciation and gratitude.
Jamie
 
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