Wiki Modifiers

[tlindo1]

I need assistance with attaching modifiers.
The patient received individual therapy (90834) and group therapy (90853) on the same day with the same provider. Then, on the same day they had another group therapy 90853 with a different provider.
Which modifiers would I use on each code?

 

[TThivierge]

Tlinod
Unless this is 2 differ providers it will not cover Hopefully a definitive dx code is used not just Z dx code as primary dx.. You could use modifiers defining the provider type by using modifier too of AJ or AH or HO.
I hope this data helps you
Lady T

 

[tlindo1]

Tlinod
Unless this is 2 differ providers it will not cover Hopefully a definitive dx code is used not just Z dx code as primary dx.. You could use modifiers defining the provider type by using modifier too of AJ or AH or HO.
I hope this data helps you
Lady T

Could modifier XE be used for the same provider, and XP used for the second provider. e.g 90853, 90834-XE, 90853-XP

 

[TThivierge]

Could modifier XE be used for the same provider, and XP used for the second provider. e.g 90853, 90834-XE, 90853-XP

Tlindo
No i would not use modifiers XE or XP for different beh health providers. However if beh. health providers treating differ dx or problems list those specific dx.
Modifiers XE or XP define add documents later if required and differ body organs
I hope this data helps you
Lady T

 

[tlindo1]

Lady T,

If the patient has individual visit with Provider A 90834 at 1:00, then has group therapy 90853 with Provider A at 3:00. Additionally has a group therapy 90853 with Provider B at 4:00 all on the same day. Billing 90834-XE,HO, 90853, 90853-XP,HO Wouldn't this show that the there was 2 distinct Providers and distinct separate encounters?

 

[TThivierge]

Lady T,

If the patient has individual visit with Provider A 90834 at 1:00, then has group therapy 90853 with Provider A at 3:00. Additionally has a group therapy 90853 with Provider B at 4:00 all on the same day. Billing 90834-XE,HO, 90853, 90853-XP,HO Wouldn't this show that the there was 2 distinct Providers and distinct separate encounters?

Tlindo
I would not send beh health session on same day to payer unless for differ dx problems. If you do one of MH visits will probably get rejected if for same dx. The modifier XE is ok but ensure the dx codes are different. Why would payer pay same beh. health session with same dx code? Also always told modifier XS and XP used for differ organs or differ specialist. So as example I guess if pt. treated for marriage counseling dx F32 and dx Z63 but then some other psychotic or sub abuse problem dx F12 and dx F41 on SAME date that be different & probably cover it. Well that s my 2 cents...hope helped you
Lady T