# Billing a psychotherapy session with an E/M code 90832, 90833, 99212



## klnastasi.kn@gmail.com

I am trying to bill a psychotherapy session along with a medication management office visit.  When billing add on code 90833, which code can be listed as the primary procedure?  Should I bill 90832 with 90833 as the add on, or can we use 99212-15 as the primary procedure and 90833 as the add on code?  Please advise

Thanks!
-Kristin


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## ckeeney

The E/M code goes first with no modifier, then the appropriate add-on psychotherapy code 90833, 90836,  or 90838. whenever the therapy is done by the same provider who performed the E/M service. Remember the time for psychotherapy does not include time rendering the E/M service. If there were two separate providers, one for therapy and another for the E/M, bill separately using the appropriate therapy (not the add-on ones) and E/M codes.


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## Jean Cosgrove

*Question regarding response to "billing a psychotherapy session with an E/M code.9083*

I have a question re: the response to the original question....

I'm hoping you can clarify your response because the CPT book specifically says (under the Psychotherapy section): "Some psychiatric patients receive a medical evaluation and management service on the same day as a psychotherapy service by the same physician OR OTHER QUALIFIED HEALTH PROFESSIONAL. To report both E/M and psychotherapy, the two services must be significant and separately identifiable. These services are reported by using codes specific for psychotherapy when performed with E/m services (90833,90836,90938) as add on codes to the e/m service."

Under the listing for code 90833, it also says to use it in conjunction with 99201-99255, etc.

Since the CPT book says that if the services are done by the same physician OR OTHER QUALIFIED HEALTH PROFESSIONAL, it seems to me that 90833 and the appropriate e/m code (99212-99215) should be billed together (with the e/m billed first), on the same encounter, with NO modifier , using the MD as the billing provider.  

I am billing 90833 (performed by psychotherapist) and 99214 (performed by our MD) on same date of service. I am billing both on same encounter/claim but using the MD as the billing provider. No modifiers.
BUT I'm getting denials on the 90833....which doesn't make sense as I'm billing exactly as CPT indicated.

Sooo, if it's at all possible, I'd love to see your source that indicates the way you described that it should be done.

Thanks ever so much for helping to clarify this VERY confusing subject.


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## Jean Cosgrove

*Question regarding response to "billing a psychotherapy session with an E/M code90833*

I have a question re: the response to the original question....

I'm hoping you can clarify your response because the CPT book specifically says (under the Psychotherapy section): "Some psychiatric patients receive a medical evaluation and management service on the same day as a psychotherapy service by the same physician OR OTHER QUALIFIED HEALTH PROFESSIONAL. To report both E/M and psychotherapy, the two services must be significant and separately identifiable. These services are reported by using codes specific for psychotherapy when performed with E/m services (90833,90836,90938) as add on codes to the e/m service."

Under the listing for code 90833, it also says to use it in conjunction with 99201-99255, etc.

Since the CPT book says that if the services are done by the same physician OR OTHER QUALIFIED HEALTH PROFESSIONAL, it seems to me that 90833 and the appropriate e/m code (99212-99215) should be billed together (with the e/m billed first), on the same encounter, with NO modifier , using the MD as the billing provider.  

I am billing 90833 (performed by psychotherapist) and 99214 (performed by our MD) on same date of service. I am billing both on same encounter/claim but using the MD as the billing provider. No modifiers.
BUT I'm getting denials on the 90833....which doesn't make sense as I'm billing exactly as CPT indicated.

Sooo, if it's at all possible, I'd love to see your source that indicates the way you described that it should be done.

Thanks ever so much for helping to clarify this VERY confusing subject.


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## ckeeney

The CPT book that we have (published by Optum) does not have the phrasing about a physician or other healthcare provider under the psychotherapy section, nor does it appear as part of the code descriptor. However, the Optum Coding and Payment Guide for Behavioral Health Services states "As an add-on code, 90833 ... performed by the same physician on the same date of services as the primary service/procedure ..." This statement also appears in the tips for the other psychotherapy add-on codes. The phrase "a physician or other qualified healthcare provider" only appears when discussing who may provide psychotherapy services. Per instructions from our state Medicaid, therapists bill under the supervising physician or PhD psychologist and a modifier is added to indicate the therapist's credential (for example, a licensed clinical social worker is AJ) and, thus, indicates that it was two distinct providers and we do not use the add-on code for the therapy. Medicare instructs that services provided by mid-levels need to be billed under their own NPI and it follows that this is not the same person providing both services.


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## mitchellde

you are reading the phrase "done by the same physician OR OTHER QUALIFIED HEALTH PROFESSIONAL"  incorrectly.  It does not mean when part is performed by one and part is performed by other health professional.  It means you can bill both the E&M with the add on with these services are provided by a physician or when these services are provided by an other qualified health professional.  Both must be performed by the same professional to be billed in this manner.  You would need to bill the psychotherapist using the non add on code under their own NPI and then bill the physician E&M service under the physician NPI you should not be using the add on code and billing it all under the MD.


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## Quaker

mitchellde said:


> you are reading the phrase "done by the same physician OR OTHER QUALIFIED HEALTH PROFESSIONAL"  incorrectly.  It does not mean when part is performed by one and part is performed by other health professional.  It means you can bill both the E&M with the add on with these services are provided by a physician or when these services are provided by an other qualified health professional.  Both must be performed by the same professional to be billed in this manner.  You would need to bill the psychotherapist using the non add on code under their own NPI and then bill the physician E&M service under the physician NPI you should not be using the add on code and billing it all under the MD.



Mitchellede:  In our outpt clinic, MD does E/M and a clinician (CSW, etc.) performs psychotherapy on same day.  Interestingly, we are billing exactly how you say to do it and have not had a problem until this month.  CGI (hired by Highmark) is asking for money back stating that they follow NCCI and an E/M cannot be billed on the same day as 90837.  In turn, they instructed to report a modifier to bypass the edit.  I'm concerned they may not know what they are talking about.  

Can anyone provide written guidelines to support our billing so we can appeal?


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## vdixon7114

I'm hoping someone can help me.  I am currently working in at the residency program and I would like to know what modifier is needed for CPT code 90832. The billing department is stating the claim  denied for a modifier? Our Behavioral health person ( psychotherapist) billed the cpt code 90832 .


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## cfordCPC

vdixon7114 said:


> I'm hoping someone can help me.  I am currently working in at the residency program and I would like to know what modifier is needed for CPT code 90832. The billing department is stating the claim  denied for a modifier? Our Behavioral health person ( psychotherapist) billed the cpt code 90832 .


The billing dept needs to provide you with more information. What is the exact denial reason?

Was it an in-office or telehealth visit? Was there another BH service performed on the same day?

What insurance denied the claim? Insurances have their own reimbursement policies that need to be taken into consideration.


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## Partha45

Check out the below one and it may help you,

HN = the rendering provider has a highest educational attainment of a bachelor’s degree
HO= the rendering provider has a highest educational attainment of a master’s degree.
HP = the rendering provider has a highest educational attainment of a doctoral degree
SA = use when billing on behalf of a PA, ANP, or CRNFA for non-surgical services. (Modifier SA is used when the PA, ANP, or CRNFA is assisting with any other procedure that does not include surgery.)
U1 = Medicaid level of care 1, as defined by each state

Reference


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