Wiki Need help with a modifer

[askomatt]

I'm helping someone with there billing who dose psychotherapy and she is doing individual therapy and also group therapy on the same day.

Now if person A goes to individual and then to the group therapy on the same day what modifier would you use?

If person B goes to two group therapies the same day and no individual therapy what modifier do you use? Would that change if they also went to an individual therapy the same day?

They were told there was (can't recall by who) and they didn't tell them what one to use. They use a computer program to do it and they are not happy with it at all for various reasons this being one of them and my books are all in storage right now because I just moved and didn't want to go and buy new ones with the new ones just about to come out.

Any help on this would be great.


Thanks

 

[amolson1325]

I'm helping someone with there billing who dose psychotherapy and she is doing individual therapy and also group therapy on the same day.

Now if person A goes to individual and then to the group therapy on the same day what modifier would you use?

If person B goes to two group therapies the same day and no individual therapy what modifier do you use? Would that change if they also went to an individual therapy the same day?

They were told there was (can't recall by who) and they didn't tell them what one to use. They use a computer program to do it and they are not happy with it at all for various reasons this being one of them and my books are all in storage right now because I just moved and didn't want to go and buy new ones with the new ones just about to come out.

Any help on this would be great.


Thanks

I would say -59 Distinct Procedural Service

 

[abyrne]

http://www.wpsic.com/medicare/part_b/policy/psych014_billing.pdf

I agree with adding the 59 modifier. See letter C: below. This is from the WPS medicare policy.

"III. Billing Guidelines
A. CPT codes 90810-90815 and 90823-90829 should not be billed on the same dates of
service as CPT codes 90804-90809 or 90816-90822.
B. CPT code 90857 should not be billed on the same date of service as 90853. CPT code
90857 should also not be billed more than once per day for the same beneficiary unless
he/she has participated in a separate and distinct group therapy session.
C. In the infrequent event that a patient has a separate and distinct individual psychotherapy
and group therapy session in one day, modifier -59 should be appended to the CPT code
for the second session."