Wiki Same Day services coding behavioral health

[sburidi25@gmail.com]

Hey hope everyone is doing well. My question is we billed 99213 provided by a certain Provider and also on the same day but at a separate time the patient had a Group Therapy, 90853 provided by another provider. These were two different services provided by two different providers at different times, but on the same day. Also, one is a Group Therapy with multiple patients and is impossible to provide this service together with an Individual Office Visit. I was curious to know what the correct modifier to use in this situation is. Would it be 25? XP? XE? none? I would appreciate if someone could reach out, as I have recently started my journey as a CPC-A. Thanks

 

[smoorehead]

The group therapy would need a modifier 59.

 

[LIA2600]

Has anyone seen claims paid with the 59 on the group code?

 

[ckeeney]

We bill many E&M office services same day as various behavioral health therapy services with different providers and had never had to use a modifier for either the E&M service or the therapy service. If you are having an issue with them not paying on same DOS, check your payer rules. If there are multiple therapy services then modifiers might be needed.

 

[Rbrubaker]

Has anyone ever billed for multiple different kinds of group therapy 90853 with the same provider on the same day? We were told by Tricare we could bill up to 4 distinct groups per day with modifier 52, (because they dont cover adolescent day treatment), but once we billed that way, they only covered one of the groups and denied the other 3.