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

[carebaugh]

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?

 

[dkrysl@compasshn.org]

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.

 

[donaldjr1969]

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.