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what code to bill when Doc does E/M and LCSW does psychotherapy same day

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carebaugh

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Perrysburg, OH
I have an office in which the physician sees the patient and charges the E/M code then the patient sees the LCSW for psychotherapy on the same day. Billing 90834 for psychotherapy but getting denied...should the add on code 90836 be billed?
 
Yes, you have to use add on codes +90833, +90836 or +90838 if you are billing for E/M on the same visit. There are good guidelines for these services in the CPT Manual, under Psychotherapy, particularly about time criteria. I hope this helps.
 
Carebaugh, if the Psychotherapy is being done by another provider besides the physician (you did mention a LCSW), then the 90834 should be paid w/o question assuming no preauthorization is required and/or the payor contract disallows that code.

This sounds like a claims error to me. If you are billing (either via EDI or paper claims) for both the E/M and the psychotherapy, are you making sure that the rendering provider NPIs are different? Also, are you filing both services on the same claim form where the psychotherapy and E/M are on two different claim lines? If so, are the rendering provider NPIs different for each line? If that's the case, try filing the E/M claim and the psychotherapy claim separately. Assuming two different providers are providing the services, I've never had a problem having an E/M paid when done on the same day as the psychotherapy.
 
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