Wiki Therapy codes 90834 and 90853

[shainer985]

Are we allowed to bill for individual therapy and group therapy on the same day. We have claims denying stating we can't bill for both on the same day due to NCCI edits. We are thinking no but want to make sure.

 

[CodingKing]

There is an NCCI edit bundling 90834 into 90853 but that doesn't necessarily mean they cannot be done on the same DOS. You need to determine if the documentation supports use of an NCCI bypassing modifier such as 59/XE for separate and distinct encounter on same day.

 

[shainer985]

90834 90845 20130101 * 0 Mutually exclusive procedures
90834 90853 20130101 20140930 1 Mutually exclusive procedures
90834 90867 20130101 * 1 Mutually exclusive procedures


How would you interpret this from the NCCI table?

Thanks!

 

[shainer985]

There is an NCCI edit bundling 90834 into 90853 but that doesn't necessarily mean they cannot be done on the same DOS. You need to determine if the documentation supports use of an NCCI bypassing modifier such as 59/XE for separate and distinct encounter on same day.

90834 90845 20130101 * 0 Mutually exclusive procedures
90834 90853 20130101 20140930 1 Mutually exclusive procedures
90834 90867 20130101 * 1 Mutually exclusive procedures

How would you interpret this from this the NCCI table. We can't use modifiers as of 9/30/2014?

Thanks!

 

[CodingKing]

90853 was a column 2 code to 90834 and allowed modifier until 9/30/14.
Effective 10/1/14 90834 became the column 2 code and modifier can still bypass

If an edit is deleted and not replaced with a new one it's no longer an edit., If they didnt want to allow modifier a new line would have been added with a 0. Sometimes, like this instance, the codes can move from column 2 to column 1 and vice versa


[TABLE="width: 1029"]
[TR]
[TD]Column 1[/TD]
[TD]Column 2[/TD]
[TD]* = In existence prior to 1996[/TD]
[TD]Effective Date[/TD]
[TD]Deletion Date
*=no data[/TD]
[TD]Modifier
0=not allowed
1=allowed
9=not applicable[/TD]
[TD]PTP Edit Rationale[/TD]
[/TR]
[TR]
[TD]90834[/TD]
[TD]90853[/TD]
[TD][/TD]
[TD]20130101[/TD]
[TD]20140930[/TD]
[TD]1[/TD]
[TD]Mutually exclusive procedures[/TD]
[/TR]
[TR]
[TD]90853[/TD]
[TD]90834[/TD]
[TD][/TD]
[TD]20141001[/TD]
[TD]*[/TD]
[TD]1[/TD]
[TD]CPT Manual or CMS manual coding instructions[/TD]
[/TR]
[/TABLE]

 

[shainer985]

Thank you for your help. I didn't even think about that. The modifier would be attached to the column 2 code?

 

[CodingKing]

Thank you for your help. I didn't even think about that. The modifier would be attached to the column 2 code?

Correct Column 2 code gets the modifier.

 

[luluespi]

This thread was from 2017, I’m having this issue currently. Any new information? They were paying as recently as July, then it started denying as “not payable separately”.