Wiki Med Management and Psychotherapy Global

[alexjale2@gmail.com]

We have noticed that just about every payor is now recouping for instances where 90832 -90837 is being billed on the same day as MD-Estpt (99212-99215) and add on 90833. The payors are stating that per the CMS NCCI guidelines 90833,99212-99215 are included in the payment for global code 90832 - 90837. So in a nutshell they are not going to pay for med management separately if therapy is billed on the same day.

Has anyone else encountered this? We dont use any modifiers, but not sure if we should be. Any direction is appreciated.

 

[carlystur]

Is the E/M a significantly, separately identifiable service? If it is, you should be adding modifier 25 to the E/M code. If it's not, then it should not be billed and would be bundled with the procedure.

Take a look at this: https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00153948

 

[lemorris]

Is the E/M a significantly, separately identifiable service? If it is, you should be adding modifier 25 to the E/M code. If it's not, then it should not be billed and would be bundled with the procedure.

Take a look at this: https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00153948

90833 is an ADD ON code. My understanding was that a modifier was not appropriate for ADD ON codes. Do you have any documentation to show a modifier is needed?

 

[carlystur]

90833 is an ADD ON code. My understanding was that a modifier was not appropriate for ADD ON codes. Do you have any documentation to show a modifier is needed?

I apologize. I only now realize that I wasn't paying super close attention to the original post and didn't notice the add-on code part. Now that I've done a better search regarding add-on codes and modifiers, I found this which doesn't really have to do with modifier 25 specifically, but this states that modifier 59 is sometimes appropriate with bundled codes: http://www.hcpro.com/HIM-253717-8160/Use-modifier-59-sparingly-when-reporting-addon-codes.html

So, please ignore my previous comment as incorrect. https://www.aapc.com/discuss/threads/use-of-modifiers-with-add-on-codes.123103/

 

[SharonCollachi]

So in a nutshell they are not going to pay for med management separately if therapy is billed on the same day.

The last time I was working full-time in mental health was about 8 years ago (I still help some people part-time). We ALWAYS had payers that wouldn't allow psychotherapy on the same day as med mgmt. Once we identified those, we had to tell the patients that if they saw another mental health provider the same day they saw us, their visit may not get paid and it would be their responsibility (and we had them sign documents to that effect). Yes, this covered DIFFERENT PRACTICES!