I have just started coding for a Psychologist. CPT 90806 for 2012 (Indiv Psychotherapy, insight oriented, behavior modifying and/or supportive, in office or OP facility) is being rejected (stating provider not certified). Can't seem to find any supporting documentation on this rejection. Any help would be appreciated.
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Wiki Psychology
- Thread starter cpeele
- Start date
airart
Guru
Codes changed in 2013
Was your denial code - CO B7 This provider was not certified/eligible to be paid for this procedure/service on this date of service?
Are you billing for dates of service in 2012? If so, verify that the correct date is on the RA/EOB, then check the effective and termination dates of the providers billing number. If both are ok, then follow your office procedures on contacting the payer for resolution.
If you are billing for dates of service in 2013, then the codes changed and you are billing with old codes and need to start billing with the correct ones. See below.
There is a crosswalk between the CPT coding options in 2012 to the CPT coding options that take effect on January 1, 2013 located on American Psychiatric Association website for members. The crosswalk doesn't show all codes, but most of the general ones used.
In addition to new numbers and revised or new descriptors, a new concept – add-on codes – has been introduced. The list includes only those codes that have been revised in some way and is not a full list of CPT codes describing psychiatric work.
90806 is now crosswalked to code 90834 for 2013.
Here is the website of the crosswalk on the new codes for 2013.
http://www.oregon.gov/oha/amh/mho/codes/apa-changes-2012-2410.pdf
Was your denial code - CO B7 This provider was not certified/eligible to be paid for this procedure/service on this date of service?
Are you billing for dates of service in 2012? If so, verify that the correct date is on the RA/EOB, then check the effective and termination dates of the providers billing number. If both are ok, then follow your office procedures on contacting the payer for resolution.
If you are billing for dates of service in 2013, then the codes changed and you are billing with old codes and need to start billing with the correct ones. See below.
There is a crosswalk between the CPT coding options in 2012 to the CPT coding options that take effect on January 1, 2013 located on American Psychiatric Association website for members. The crosswalk doesn't show all codes, but most of the general ones used.
In addition to new numbers and revised or new descriptors, a new concept – add-on codes – has been introduced. The list includes only those codes that have been revised in some way and is not a full list of CPT codes describing psychiatric work.
90806 is now crosswalked to code 90834 for 2013.
Here is the website of the crosswalk on the new codes for 2013.
http://www.oregon.gov/oha/amh/mho/codes/apa-changes-2012-2410.pdf
airart
Guru
Plan?
Which plan denied with the B7? Was it Medicare Part B?
Which plan denied with the B7? Was it Medicare Part B?
airart
Guru
DX? Per LCD - L27514 Psychiatric Therapeutic Procedures
Hopefully the LCD can help you.
Hopefully the LCD can help you.