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Therapy Codes (Psychologist) - Bundling

  1. #1
    Default Therapy Codes (Psychologist) - Bundling
    Medical Coding Books
    I have just recently started billing for a Psychologist in an Inpatient
    Child Psych Ward.
    I am getting edits saying I cannot bill Group Therapy (90853) with Family Therapy (90847) on the same date of service, Group Therapy (90853) with Individual Psychotherapy (90816/90818) on the same date of service or Family Therapy (90847) with Indiviaual Psychotherapy (90816/90818) on the same date of service.
    I cannot find in Medicare's guidelines where these can't be billed together.
    I did find in Medicaid's guidelines that Group Therapy (90853) could be billed with Family Therapy (90847) on the same date of service if the patient is an inpatient.
    Should I use a 59 Modifier?
    If so on which procedure or all of them?
    I would appreciate any input that anyone might have.
    Thank you.

  2. #2

  3. #3
    Location
    Columbia, MO
    Posts
    12,843
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    Quote Originally Posted by klempkec View Post
    I have just recently started billing for a Psychologist in an Inpatient
    Child Psych Ward.
    I am getting edits saying I cannot bill Group Therapy (90853) with Family Therapy (90847) on the same date of service, Group Therapy (90853) with Individual Psychotherapy (90816/90818) on the same date of service or Family Therapy (90847) with Indiviaual Psychotherapy (90816/90818) on the same date of service.
    I cannot find in Medicare's guidelines where these can't be billed together.
    I did find in Medicaid's guidelines that Group Therapy (90853) could be billed with Family Therapy (90847) on the same date of service if the patient is an inpatient.
    Should I use a 59 Modifier?
    If so on which procedure or all of them?
    I would appreciate any input that anyone might have.
    Thank you.
    Do check the CCI edits, however I do believe you can bill these together and yes you will need the 59 modifier on the one with the lesser RVUs. Your documentation must reflect that each separate therapy being billed occurred in a separate session at a separate time of the day. The reason (possibly) you are getting a bundled edit is that they do not want you billing for multiple therapies occurring all at the same time. Just a thought.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Location
    Louisville, KY
    Posts
    1,101
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    Debra did a really good job of explaining how to correctly code those encounters. The one, other deciding factor I'd mention is that you should look at what providers are supplying these services to the patients. Is this the same psychologist providing all these the same DOS or more than a single provider?

    If you have separate providers independently meeting with the patient and one moderating family therapy (as an example) and a different provider doing group therapy, then also you'd need to report those separately.

    Good luck.

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