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Can I bill a 90801 again??

  1. Default
    Medical Coding Books
    Quote Originally Posted by lizalambert View Post
    I am having a similar problem. Therapist saw client at a one site, saw her for therapy then after 3 months decidided to see her at other site but needed a 90801 to open her to the new site. i checked with her insurancea and yes if they stop coming for 6 months you can do another 90801. my problem however is she was being seen for the full 3 months then he did an intake form to open her to the new site but wants to bill it as a 90806 since we wont get paid for another 90801. does anyone know the rules about this? i say no you cant bill a 90806 when the documentation clearly shows a 90801.
    help please they wont believe me
    "needed a 90801 to open her to the new site"
    If he has already been consistently treating this patient, why would he need to do another 90801? Couldn't ha just have had copies of her records sent over to the new location? I guess I would question the necessity of another visit..

  2. #12
    Default
    You are correct. You can only bill for what you actually document not for reimbursement purposes. If you would like to find something in writing you may want to check the coding guidelines in your CPT book, Medicare NCD or LCD, and/or with your local payer.

    Coding and billing for something they didn't do will get them into trouble.
    Donna E. Young, CPC

  3. Default
    A little late in finding this forum, but I work for a state agency that services consumers with mental health, substance abuse and developmental disabilities and the contracts that we as a state agency and Community Service Board allows the code 90801 to be provided once every 6 months and in the case of an urgent need such as a consumer that stopped services and completed decompensated then a preauth is required. Medicaid allows for the 90801 yet monitors as the same with Medicare. We utilize LCSWs and since Medicare only pays for an MD, CNS, PhD, LCSWs our LCSWs will provide the initial assessment to determine the level of service and if the consumer meets core criteria and then an appointment is made to see a physician who will then also bill 90801 and since the NPI designates the licensure we have experienced any problems with Medicare. Medicaid uses alot of H codes so a clinician can always bill H0031 or H0032 and then the physician can bill 90801.

    Hope this helps...
    Wendy, CPC

  4. #14
    Default Paper work involved in doing the 90801
    Can we include the time doing paper work for the 90801 procedure code? A lot of times it would take our clinicians to do 90801 for 1 hour and another 1/2 hour to finish the paper work. Should we code it with 90801-22? Please help.

    thanks,
    Raquel

  5. Default
    Quote Originally Posted by rnakahara View Post
    Can we include the time doing paper work for the 90801 procedure code? A lot of times it would take our clinicians to do 90801 for 1 hour and another 1/2 hour to finish the paper work. Should we code it with 90801-22? Please help.

    thanks,
    Raquel
    90801 does not have a time value assigned to it per CPT, so no, you should not bill a 90801-22.

  6. #16
    Smile
    Quote Originally Posted by rnakahara View Post
    Can we include the time doing paper work for the 90801 procedure code? A lot of times it would take our clinicians to do 90801 for 1 hour and another 1/2 hour to finish the paper work. Should we code it with 90801-22? Please help.

    thanks,
    Raquel
    Funny I was just re-reading about this today in the CPT Handbook for Psychiatrists. It states that a 90801 is not a timed code, but the initial eval generally takes 45 minutes to an hour. In instances where the eval would take longer than that, the CPT, modifier -22 should be used. Be sure to document the extra time and explain why it was required.

    BUT I guess this wouldn't work in your case because it's relating the extra time to the actual eval not paperwork.

    Hope this helped.
    Donna E. Young, CPC

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