Wiki Same day 90853 (Group) and 90837 (Individual) with 59 modifier claims being denied

[ntmenendez@hotmail.com]

Hello, my commercial claims are denying when same practitioner provides both 90853 and 90837 w/59 modifier same day. Behavioral Health. Any advice please and thank you.

 

[Lauren423]

I have had success with mod 59, but I haven't billed one in a while. Maybe try mod XE? If it is still denied, document the heck out of it and submit an appeal.

 

[ntmenendez@hotmail.com]

I have had success with mod 59, but I haven't billed one in a while. Maybe try mod XE? If it is still denied, document the heck out of it and submit an appeal.

Thank you, I'll try HE.

 

[TThivierge]

Hello, my commercial claims are denying when same practitioner provides both 90853 and 90837 w/59 modifier same day. Behavioral Health. Any advice please and thank you.

Ntmenendez
This will be denied if for the same diagnosis code. The services CPT 90853 and 90847 should be distinct & documentation not for same MH problem. Also the 90847 with parents present is usually for teens, or marital counseling or ADHD or autism. I hope proper minutes are documented in record for each and need to be atleast 26 minutes for 90847. I hope this data helps you. Oh yes did put modifier for type of clinician AJ or AH or AF?
Lady T:

 

[ntmenendez@hotmail.com]

Ntmenendez
This will be denied if for the same diagnosis code. The services CPT 90853 and 90847 should be distinct & documentation not for same MH problem. Also the 90847 with parents present is usually for teens, or marital counseling or ADHD or autism. I hope proper minutes are documented in record for each and need to be atleast 26 minutes for 90847. I hope this data helps you. Oh yes did put modifier for type of clinician AJ or AH or AF?
Lady T:

Thank you for your time and reply. I am actually not billing for family. I am billing 90853 Group and 90837 individual therapy same day. Notes are separate/distinct and over 60 min each.