Wiki Office visit E/M (MAT) and behavioral health coding

[wolbrum]

I just started with a client that does Medication Assisted Treatment (MA.T) The way they have been billing, is that the provider who does the medication management portion (and any other conditions) will bill the office visit E/M code with a modifier 25, and the counselor bills a 90832/90834/90837 with mod 59. Most payers deny the counseling code. My question is, the counselor is a "certified substance abuse counselor," should she billing 90833-90836/90838 instead? And since it is an add on code can it be billed from a different provider that is performing the OV? I just think that the way they are billing is incorrect. Thanks,

 

[TThivierge]

Hi Wolbrum,
Is your SA counselor a LCSW or LPC or QHP? Yes they all can per the CPT manual pgs 648-649. Add on codes have to follow parent codes stand alone codes (90832 + 90833 or 90839, +90840 crisis) by same provider. And yes you can bill both together psych CPT and Eval Mgmnt codes but the catch is are the providers discussing(documenting) the ongoing chronic medical illness and the BH services on the treatment for the day?. Then you would link the proper CPT with differ dx reviewed. As an example : the patient has ongoing back aches dx M54 and DM E11.9 but get treated also for Depression F32 and F06 Moods or Sleep Apnea dx. G47.30 . Minutes/time should be given for mental and medical illness documented in the record what is discussed and meds for each problem. Then link dx F32 and F06, with the beh. health CPTs and the eval & mgnt CPT with dx M54,G47 and DM E11.9. the Psychiatrist, NP, PA can bill anything but the LSCW should stick with the beh health codes.
I hope this data helps you.
Lady T

 

[ckeeney]

We have MAT physicians and therapists billing for services on the same day. We do separate claims: the E&M for the MAT physician on one claim and the therapist's service on a separate claim that, depending on the payer, may be billed under either the supervising physician with the appropriate provider type modifier (HE, AJ, etc.) or the therapist if they are credentialed with the payer. Occasionally, again depending on the payer, we may need to add a modifier from the X_ series for separate provider/separate service. They often have the same diagnosis codes. We do not use either the -25 or the -59 modifiers nor the add-on codes that should only be used if the physician provided the therapy in addition to the E&M.