Practice Management Alert

Question: Full disclosure: I am new to psychiatry, and I just accepted a practice manager position at a psychiatric clinic. Some of my new duties involve some light coding, which brings me to my issue. I recently sent out a claim for a psychotherapy session (90834) conducted by our clinical social worker (CSW), but it was rejected. The payer’s reason for rejection stated that a modifier was missing for the claim. I thought it was a straightforward claim, and I am not too sure about the need for any modifier. Can you tell me where I have gone wrong, so I will be able to correct the claim and receive reimbursement, plus know how to do this going forward?

Oklahoma Subscriber

Answer: Some payers may require the use of Healthcare Common Procedure Coding System (HCPCS) modifiers like AH (Clinical psychologist) or AJ (Clinical social worker) when filing claims for services performed by a clinical social worker (CSW) or a clinical psychologist (CP), respectively. These HCPCS modifiers let the payer know that the provider who performed the service was a qualified CP or CSW, as per Medicare guidelines.

You should list these modifiers in field 24d of the CMS 1500 form. Make sure you place the modifier after the CPT^® code that you report for the services performed. In your instance, since you are claiming for psychotherapy session that was performed by your clinical social worker, you will need to report 90834 (Psychotherapy, 45 minutes with patient and/or family member) with the modifier AJ appended to the code.

But, according to guidelines issued in Transmittal 2656, CMS mentions that, “Contractors shall not require the submission of modifier AJ for clinical social workers (CSWs) or modifier AH for clinical psychologists (CPs).” The transmittal also clarifies that modifiers AJ and AH are not eliminated, but they no longer need to be submitted with the claims.

Best bet: Check payer policies and rules to see if you should use modifiers AJ and AH when you are submitting claims for services provided by your clinical social worker or your clinical psychologist, so you do not run the risk of denial.