Wiki Anthem questioning use of 90837

[bridgettemartin]

We have a PsyD that received a payer letter indicating they are billing a higher number of 60 minute therapy visits (90837) than their peers. We do Bell Curves and benchmarking, but do not have access to benchmarking tools for Psychotherapy codes.

Therapy codes are time based. If they provide 60 minutes, you bill the 60 minute code. I'm a little confused as to why a payer would question that.

Wondering if anyone might be able to provide some insight.

 

[mitchellde]

It may be diagnosis driven as well.. I would see what exactly the provider is documenting and for what diagnosis. The question is not always how much time you spent, but given the diagnosis should that have been the case.

 

[bridgettemartin]

Thanks for the feedback. I hadn't thought of that for this scenario.

If that is the case, I wonder how the payer determines which codes support 60 minute visits. Especially when the Provider states the time is justified.