Quantity billing 90862

1073358

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I am in WI. Our MA policy says for billing 90862, we must use rounding guidelines they provide. Basically it says 15 min= 1 unit. Therefore 30 min= 2 units. Alot of times we do have 30 min 90862's. Is it appropriate to bill 2 units to MA and only 1 unit to all other payors? MA is saying bill this way, but I have concerns billing 2 units to them and only 1 everywhere else. I would appreciate some feedback on this issue. Would this fall under billing differently to different insurances to get paid more? I know thats a no no. I just don't know what to think.
 

deyoung

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It's just my opinion but I would say bill what the doctor actually did, the same way to all insurances, and allow the insurance to pay for the portion they allow and deny what they don't.
 
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Rounding guidelines

This is not my area of expertise, but ...

By rounding guidelines they mean that if you have 15 minutes you round up to the nearest unit of 30 minutes.

You also write: Therefore 30 minutes = 2 units. Is this specifically stated this way in the guidelines? Or are you making that assumption based on the guidance to round up the 15 minutes to 1 unit?

Also, I don't see any mention of time in the CPT for 90862 ... Do you mean a different code?

Finally, it's possible that WI MA has not updated their guidelines to reflect current code books; so the code may be wrong in their guidelines. (Hard to believe, I know.)

Hope that helps

F Tessa Bartels, CPC, CEMC
 
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readingfool

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90862 unit billing

in PA we have a similar situation with medical assistance with the 90846, 90847 and 90853 - they want it billed in 15 minute increments with a minimum of 4 units. Some medical assistance programs do not feel the need to change their policy to match the rest of the world. I can say that I have never heard of billing a med check in units - verify with MA if there is a minimum number of units that need to be billed
 

rnakahara

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I am in WI. Our MA policy says for billing 90862, we must use rounding guidelines they provide. Basically it says 15 min= 1 unit. Therefore 30 min= 2 units. Alot of times we do have 30 min 90862's. Is it appropriate to bill 2 units to MA and only 1 unit to all other payors? MA is saying bill this way, but I have concerns billing 2 units to them and only 1 everywhere else. I would appreciate some feedback on this issue. Would this fall under billing differently to different insurances to get paid more? I know thats a no no. I just don't know what to think.
since this code is meds management with minimal psych therapy if the service goes over 30 mins aren't you suppose to code that as 90805 already if your doc is spending that much time with the patient.
 

1073358

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since this code is meds management with minimal psych therapy if the service goes over 30 mins aren't you suppose to code that as 90805 already if your doc is spending that much time with the patient.
It would depend on the documentation and the intnet of the visit. I suppose that in rare instances, they could spend +30 minutes discussing concerns with meds, which doesnt necessarily mean its a 90805.
 

drirbyhunter

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90809 75-80 minutes

when using 90809 are the associated E/M service procedures included in the 75-80 minutes are does the provider have to provide face to face services for the entire time
 
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90809

drirbyhunter writes: when using 90809 are the associated E/M service procedures included in the 75-80 minutes are does the provider have to provide face to face services for the entire time

Yes. And cannot also be attending to any other patients.

F Tessa Bartels, CPC, CEMC
 
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