Wiki Same Day Service Question

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wgmarrs

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Apologies if this should have gone under Billing instead of Behavioral Health.

We are attempting to bill a physician E/M service on the same day as another practitioner provides psychotherapy - a 90834, specifically. Given the changes in the use of the -59 modifier, would we be correct in adding the new XP modifier (separate practitioner) to the 90834 therapy code? TIA.
 
I am looking for answers to the same type of scenario, just wondering if you found a resolution and if the XP modifier was the right way to go?
 
If client 'Rebecca' was seen at an agency in which the psychiatrist and the therapist are both employed and she saw both of them on the same day, the CPT rules state "Some psychiatric patients receive a medical evaluation and management (E/M) service on the same day as a psychotherapy service by the same physician OR other qualified health care professional. To report both E/M and psychotherapy, the two services must be significant and separately identifiable. These services are reported by using codes specific for psychotherapy when performed with evaluation and management services (90833, 90836, 90838) as add-on codes to the evaluation and management service."
Therefore when client 'Rebecca' saw therapist 'Roy' and then saw psychiatrist 'Dr. J', the therapist writes an service note and the psychiatrist writes an E/M note and I bill the appropriate E/M service code with the appropriate add-on code such as: 99213 and 90833. These codes are billed together and cover both services. The therapist does not bill separately.
It looks like you are trying to bill the E/M CPT code for the physician and the 90834 with the XP modifier for the psychotherapy service which would be incorrect billing.
 
billing

what is client "Rebecca" saw primary care dr for 99213 then saw lcsw for 90832. How would this be billed appropriately? Thank you
 
wgmarrs said:
Apologies if this should have gone under Billing instead of Behavioral Health.

We are attempting to bill a physician E/M service on the same day as another practitioner provides psychotherapy - a 90834, specifically. Given the changes in the use of the -59 modifier, would we be correct in adding the new XP modifier (separate practitioner) to the 90834 therapy code? TIA.
Click to expand...

Did you have success with the XP modifier? We're having the same issue at our agency. This was a post I did on a similar thread from a few weeks ago:

I'm fairly new to behavioral health billing, but I've heard of our agency having the same issue; especially with our Medicaid/MCO clients. Our Reimbursement Manager contacted the Medicaid MCO's Billing Manager and we were advised to use a modifier 25 on the E/M charge, but (shocker), the claims were rejected. We've since done some appeals and they've been hit or miss from what I've heard. This said, when I looked into this with VA DMAS I found that therapy provided by a LCSW or LPC wasn't reimbursable with an E/M visit provided by a doctor, but a CNS was.

Blah. If you find out any other info I'd be interested to know.

Lena
 
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