PH Medicaid

[metcalfc]

in need of some help. Clinician usually sees patient for 60 min 90837 however this certain visit they saw patient for 2 hours. They are questioning how to write their note and since medicaid has a 20 visit limit how would this be coded and will they cover a "2 unit" visit?

 

[mitchellde]

Even if they have a stated 20 min limit you would not submit the 90837 with two units. You would, following the directions in the CPT book, use the 90837 with a 99354 for an encounter of greater than 90 minutes. You will need really good rationale as to why the visit exceeded to Medicaid limit and you usual timeframe of 1 hour. If this was a patient in crisis then you should look at the 90839 with the 90840.

 

[metcalfc]

Even if they have a stated 20 min limit you would not submit the 90837 with two units. You would, following the directions in the CPT book, use the 90837 with a 99354 for an encounter of greater than 90 minutes. You will need really good rationale as to why the visit exceeded to Medicaid limit and you usual timeframe of 1 hour. If this was a patient in crisis then you should look at the 90839 with the 90840.

Thanks!!