Wiki individual psychotherapy 90806 90807

[genacodes]

I have a payer that states that it inappropriate for a pediatric psychotherapist to bill a 90806. They state that 90807 is appropriate billing.

The only difference between the two codes is that the 90807 includes the E&M.

Has anyone heard of this before? I am not familiar with Psychiatric codes.

Is this true?

 

[andersee]

Was an E&M done? For psychotherapy the E&M would typically look like medication management. If this was not done, it sounds like 90806 would be more appropriate. I recently dis a lot of research on psych codes.

 

[genacodes]

An E&M was not done, but if med management was done should we be using the 90807.

Also, have you heard that it is inappropriate for a psychiatric MD to bill 90806?

Thanks

g

 

[andersee]

If med management was done and documented, this constitutes the E&M portion of 90807. It is not inappropriate for an MD to bill 90806. Here is Noridian's presentation on mental health codes: https://www.noridianmedicare.com/p-medb/train/presentations/mental_health.pdf

Hope this helps.

 

[dragonflye]

Hi. I used to work for a psychiatrist/therapist in maryland. We always used codes 90804 and 90806 for therapy (therapist) visits. Used codes 90805 and 90807 for psychiatry with med management, as long as the psychiatrist saw the patient for what ever reason it was billed 90805 or 90807.

 

[bsdfo]

I tired to open

https://www.noridianmedicare.com/p-m...tal_health.pdf

but it could not be found.