Wiki Is this at all billable?

[laurenmowens@yahoo.com]

Hello! I'm a super new coder and the only one my practice has. I need a little assistance with a recent head scratcher situation:
A therapist who is in network with BCBS was asked to attend an hour long IEP meeting for a client, but was dismissed after 10 minutes for not being relevant to the discussion. This therapist has written up a few developmental profiles on the client as requested by the parents for certain meetings including this IEP meeting. Even though those documents were created without the patient present, is there any way for us to compensate her time on this case as far as insurance goes? In total, she's calculated around 90 minutes of time spent around this client. I saw another thread in an AAPC forum where the person was told these are just good deeds for the day, but is that all we can do to speak to the amount of time put into this client on the insurance side?

 

[sls314]

Hello! I'm a super new coder and the only one my practice has. I need a little assistance with a recent head scratcher situation:
A therapist who is in network with BCBS was asked to attend an hour long IEP meeting for a client, but was dismissed after 10 minutes for not being relevant to the discussion. This therapist has written up a few developmental profiles on the client as requested by the parents for certain meetings including this IEP meeting. Even though those documents were created without the patient present, is there any way for us to compensate her time on this case as far as insurance goes? In total, she's calculated around 90 minutes of time spent around this client. I saw another thread in an AAPC forum where the person was told these are just good deeds for the day, but is that all we can do to speak to the amount of time put into this client on the insurance side?

I will preface my response by saying that I'm not a mental health coder. I am not sure if there is a CPT code that would encompass the work that the therapist performed.

However, even if a CPT code existed, you may still run into a benefit issue on the patient's plan. If this is confirmed to be a non-covered service for insurance, I would investigate whether the therapist could charge families a reasonable fee.

I think it would be unfair to charge this family without discussing it in advance, but establishing an office policy could be useful for similar situations in the future.

I'd recommend checking with official organizations such as the state licensing board and any relevant professional organizations to investigate the legalities/ethics of charging a fee for that type of extra work, when it wouldn't be covered by insurance.

 

[laurenmowens@yahoo.com]

I will preface my response by saying that I'm not a mental health coder. I am not sure if there is a CPT code that would encompass the work that the therapist performed.

However, even if a CPT code existed, you may still run into a benefit issue on the patient's plan. If this is confirmed to be a non-covered service for insurance, I would investigate whether the therapist could charge families a reasonable fee.

I think it would be unfair to charge this family without discussing it in advance, but establishing an office policy could be useful for similar situations in the future.

I'd recommend checking with official organizations such as the state licensing board and any relevant professional organizations to investigate the legalities/ethics of charging a fee for that type of extra work, when it wouldn't be covered by insurance.

Thank you for your reply. I will talk with the practice about charging this in house if there is in fact no code that would apply for reimbursement. I know another practice who requires paperwork be completed with the patient present as part of the appointment to be able to charge it to insurance.