Wiki Session length

[Cwaples]

Scenario- Provider has an appt from 8am-9am for a psych eval. The eval lasts less 45 minutes vs an hour but the provider does not change the time in the notes. There is no specific time length for the code which the provider billed-90792. Are there any potential negative impacts? Would this be considered fraud?

What about the same scenario and the client walks out of the appt after only a few minutes and the provider is unable to complete the eval. Would it still be billable?

 

[thomas7331]

Since the 90792 is not a time-based code, it isn't really material to the coding and billing if the evaluation did not take up the full hour of the appointment. It could be considered poor quality or an error if the time is inaccurate, but not fraud if there's no intent to inflate the payment.

In the second case, if the provider did not complete the evaluation, then it would not be appropriate to bill for it. CMS guidelines in say that if there is a code that represents the procedure that was actually completed, that should be used instead, and if not, then an appropriate modifier should be used to indicate that the services were reduced or discontinued (e.g. modifier 52).