Medical Billing Forum

Payments => Insurance Payments => : rdmoore2003 January 15, 2013, 01:22:39 PM

: BLUE CROSS BLUE SHIELD
: rdmoore2003 January 15, 2013, 01:22:39 PM
has anyone received payments from blue cross blue shield for medication visits with a medical psychologist yet?

I billed a 90863 with add on therapy code and we are being reimbursed for therapy code and not med check.  of course bcbs does not know how they are to process and the reimbursement for the therapy code is higher than the allowed amount for the 90863...
: Re: BLUE CROSS BLUE SHIELD
: PMRNC January 15, 2013, 03:35:33 PM
Even though the new codes do account for prescribing psychologists, only those in NM and LA are being considered according to scope of license restrictions in those states.   IN New Mexico and Louisiana a 90863 has to be used with either 90832, 90834 or 90837.   
: Re: BLUE CROSS BLUE SHIELD
: rdmoore2003 January 15, 2013, 04:56:28 PM
Even though the new codes do account for prescribing psychologists, only those in NM and LA are being considered according to scope of license restrictions in those states.   IN New Mexico and Louisiana a 90863 has to be used with either 90832, 90834 or 90837.

this is exactly how I coded it.   blue cross is paying only the therapy code and not the 90863 code...
: Re: BLUE CROSS BLUE SHIELD
: PMRNC January 15, 2013, 05:57:35 PM
this is exactly how I coded it.   blue cross is paying only the therapy code and not the 90863 code...

Right but are you in NM or LA? If not that's why.
: Re: BLUE CROSS BLUE SHIELD
: rdmoore2003 January 15, 2013, 06:16:30 PM
this is exactly how I coded it.   blue cross is paying only the therapy code and not the 90863 code...

Right but are you in NM or LA? If not that's why.

Yes, I am in LA.
: Re: BLUE CROSS BLUE SHIELD
: rdmoore2003 January 15, 2013, 06:19:31 PM
I coded 90863 on line 1 and 90832 on line 2.   they paid 90832 but did not for 90863 with denial of:  N01- Procedure is Integral to another procedure.
: Re: BLUE CROSS BLUE SHIELD
: PMRNC January 15, 2013, 06:29:39 PM
Ok, this is from notes I took at a webinar:

A CPT code of 90863 (ADD ON CODE) was added for PRESCRIBING psychologists only.   90863 - Pharmacologic Management, including prescription and review of medication WHEN PERFORMED WITH PSYCHOTHERAPY SERVICES Do NOT report 90863 If already reporting an E/M service and add on psychotherapy code 90833, 90836 or 90838

So I'm thinking you need the appropriate E/M and the 90863 is your Add on
: Re: BLUE CROSS BLUE SHIELD
: rdmoore2003 January 16, 2013, 12:24:26 PM
ok lets try that...thanks linda
: Re: BLUE CROSS BLUE SHIELD
: PMRNC January 16, 2013, 06:37:04 PM
Your welcome.. let me/us know what happens :)
: Re: BLUE CROSS BLUE SHIELD
: rdmoore2003 January 18, 2013, 01:58:31 PM
my medical psychologists' board has found out that blue cross is not accepting the add on codes.  basically, he is to use e/m code only.
: Re: BLUE CROSS BLUE SHIELD
: PMRNC January 18, 2013, 02:09:52 PM

my medical psychologists' board has found out that blue cross is not accepting the add on codes.  basically, he is to use e/m code only.

We've not had any problem with BCBS over new codes at all. In fact our BCBS announced in a letter that the old codes would be denied. If I were you, I would request an agent to guide you to documentation to show they are not accepting the new codes and I would find out what THEY intend to do about it since it is mandatory to use as of 1/1/2013.  Lowering your reimbursement and only accepting DELETED or OLD codes would be completely unacceptable to me.
: Re: BLUE CROSS BLUE SHIELD
: rdmoore2003 January 18, 2013, 04:14:46 PM
blue cross is not having my medical psychologist use old codes.   we are new to the e/m codes and yes we do have documentation that shows that they will not cover a "medication visit w/therapy"   Documentation shows that he must do 1 or the other per day. 
: Re: BLUE CROSS BLUE SHIELD
: PMRNC January 18, 2013, 04:18:26 PM
blue cross is not having my medical psychologist use old codes.   we are new to the e/m codes and yes we do have documentation that shows that they will not cover a "medication visit w/therapy"   Documentation shows that he must do 1 or the other per day. 

Ahhh ok, that's a bit different than saying they won't cover the new codes.
: Re: BLUE CROSS BLUE SHIELD
: rdmoore2003 January 22, 2013, 07:31:22 PM
blue cross is not having my medical psychologist use old codes.   we are new to the e/m codes and yes we do have documentation that shows that they will not cover a "medication visit w/therapy"   Documentation shows that he must do 1 or the other per day. 

Ahhh ok, that's a bit different than saying they won't cover the new codes.

BLUE CROSS IS NOT COVERING THE NEW CODES AS 90863, 90833, 90836 ETC FOR MEDICAL PSYCHOLOGISTS
: Re: BLUE CROSS BLUE SHIELD
: PMRNC January 22, 2013, 08:08:37 PM
BLUE CROSS IS NOT COVERING THE NEW CODES AS 90863, 90833, 90836 ETC FOR MEDICAL PSYCHOLOGISTS

Right, it's a scope of licensure denial of services for that scope of license of that provider. I just was clarifying that it was NOT an issue of the carrier NOT acknowledging the new codes over the old. 
: Re: BLUE CROSS BLUE SHIELD
: Sportsmom April 12, 2013, 06:34:32 PM
If you have a fax number I can fax you a great cross walk I got from a class I took from the American Academy of Child and Adolesecent Phsychiatry.
: Re: BLUE CROSS BLUE SHIELD
: rdmoore2003 April 17, 2013, 07:17:22 PM
I AM NOT HAVING ANYMORE ISSUES WITH BC, HOWEVER, EMAIL ME WITH YOUR CROSSWALK INFORMATION.  I WOULD APPRECIATE THAT
: Re: BLUE CROSS BLUE SHIELD
: Sophrosyne November 05, 2013, 01:20:28 PM
I'd love to get some clarification on this thread. I just (like, yesterday) started at a practice with licensed medical psychologists who have been billing either 90834/90837 with the 90863 add on code. BCBS has been paying just for the psychotherapy codes, but not the 90863. Is there a way to get BCBS to pay for it? Other insurance companies HAVE paid for both.
: Re: BLUE CROSS BLUE SHIELD
: Sophrosyne November 05, 2013, 01:21:15 PM
And we are in Louisiana  :)
: Re: BLUE CROSS BLUE SHIELD
: rdmoore2003 November 05, 2013, 07:42:02 PM
And we are in Louisiana  :)

So am I.  What part?    BCBS will pay the following examples until Jan. 1, 2014.

For a med check it must be billed with e/m code and 90833, 90836, or 90838.  BcBS will not pay for the e/m code but will pay for med check code. 
: Re: BLUE CROSS BLUE SHIELD
: rdmoore2003 November 05, 2013, 07:45:46 PM
bcbs is not covering 90863
: Re: BLUE CROSS BLUE SHIELD
: PMRNC November 06, 2013, 11:32:30 AM
Because med management code 90862 was deleted prescribing providers instead needed to use the E/M code. IN Your situation(s) your prescribing provider is a psychologist in one of the two states that allow them to prescribe, however they cannot bill E/M codes..   With that in mind what if you billed your psychotherapy code along with HCPCS M0064. M0064 is used by those provider's performing a quick med check, it cannot be billed with any E/M service and is meant to just be a code used when only a small portion (general rule is 15 min or less) of the visit is for medication management/prescription.

Just a thought. I have psychiatrists who use this code since Medicare began cracking down on Nursing home visits for 90862.

 
: Re: BLUE CROSS BLUE SHIELD
: rdmoore2003 November 06, 2013, 12:23:19 PM
Because med management code 90862 was deleted prescribing providers instead needed to use the E/M code. IN Your situation(s) your prescribing provider is a psychologist in one of the two states that allow them to prescribe, however they cannot bill E/M codes..   With that in mind what if you billed your psychotherapy code along with HCPCS M0064. M0064 is used by those provider's performing a quick med check, it cannot be billed with any E/M service and is meant to just be a code used when only a small portion (general rule is 15 min or less) of the visit is for medication management/prescription.

Just a thought. I have psychiatrists who use this code since Medicare began cracking down on Nursing home visits for 90862.

Medical psychologists can bill E/M codes.  Medical psychologists cannot use the M code
: Re: BLUE CROSS BLUE SHIELD
: rdmoore2003 November 06, 2013, 12:25:17 PM
bcbs is not covering 90863

for medical psychologists that is
: Re: BLUE CROSS BLUE SHIELD
: PMRNC November 06, 2013, 01:51:34 PM
I should have clarified.. Medical psychologists cannot bill E/M codes to MEDICARE. Remember MOST carriers follow Medicare, hence BCBS won't allow you to bill the E/M for this provider. Their licensure requirements for prescribing does not include evaluation and management..

Psychologists cannot bill Evaluation and Management (E&M) codes when treating Medicare beneficiaries because the Center for Medicare and Medicaid Services (CMS) currently restricts the use of these codes. CMS has taken the position that E & M codes involve services unique to medical management, such as medical diagnostic evaluation, drug management, and interpreting laboratory or other medical diagnostic studies.
Although there are some similarities among the services, the health and behavior codes should not be viewed as a substitute for E&M codes. APA is continuing its advocacy with CMS to permit psychologists to be reimbursed for providing E&M services to Medicare beneficiaries.
Psychologists treating patients with private insurance may be able to bill for E&M services because not all insurers impose the same restrictions as Medicare. Psychologists should check with the private carrier to determine its policy on E&M services.
    -- Source APA

M0064 can be used in lieu of the old 90862, however  it is for the "soul purpose of monitoring....." and you wouldn't be able to bill it with psychotherapy.

I think it's important to remember there are ONLY two states right now that allow specialty licenses to psychologists for the purpose of prescribing So this is one of those things those two states have to deal with. There won't be allowances for med management on same day with separate reimbursement.  Since BCBS follows Medicare guidelines that is why you will receive the denials and I can't see a way around it because you can't bill the E/M. If you could your problem is solved as you would use the medical evaluation mgmt code with your add on therapy code, but again, you can't do that due to the type of provider.
: Re: BLUE CROSS BLUE SHIELD
: rdmoore2003 November 06, 2013, 02:21:47 PM
Here is my clarification on this:  my medical psychologist can bill e/m codes, with and without add on codes, for every insurance that we are paneled with except medicare and tricare.  tricare requires 90863 with therapy add on.  (example: 90863 & 90832).
None of our paneled insurance will except the M0064, this is only for  psychiatrists. (per our paneled insurances here)
Now, this is per our contracts, fee schedules, etc. It is all in writing and I have not had any issues all year with payments or denied claims.  It was nerve racking at first because there is only 2 states that have this type of provider.  It is simple and the APA and State board does have guidelines for this that you can get.
: Re: BLUE CROSS BLUE SHIELD
: rdmoore2003 November 06, 2013, 02:25:41 PM
including blue cross blue shield
: Re: BLUE CROSS BLUE SHIELD
: PMRNC November 06, 2013, 05:51:47 PM
If you look at some of your contracts.. let's take Value Options for example, they actually sent providers clarification on using M0064 and their allowance was for "prescribers".  HOWEVER this still wouldn't help you even if you could bil lit UNLESS the patient was coming in ONLY for a med check.   Your issue is that BCBS is following Medicare rules and many DO that using Medicare as the base guideline. In any other state your provider wouldn't be doing E/M or medication mgmt at all. The issue is that the scope of license is recognized, but the carriers still can determine if they want to pay a med mgmt code WITH therapy on same date. If you were in any other state OR if your provider was a psychiatrist you would have no problems with the E/M and add on's.   JMHO but if I was in your position I'd have my provider / client refer out for med checks as they are losing reimbursement due to the restrictions and coverage guidelines.
: Re: BLUE CROSS BLUE SHIELD
: Sophrosyne November 07, 2013, 07:50:45 PM
Thanks for all the advice! I just recently received an email from BCBS saying: "Effective January 1, 2014, BCBSLA will allow payment for E&M codes and the following psychotherapy codes when billed on the same claim: CPT codes 90833, 90836, 90838." They don't say anything about same date of service, but we'll see how it goes!
: Re: BLUE CROSS BLUE SHIELD
: PMRNC November 07, 2013, 07:52:51 PM
Thanks for all the advice! I just recently received an email from BCBS saying: "Effective January 1, 2014, BCBSLA will allow payment for E&M codes and the following psychotherapy codes when billed on the same claim: CPT codes 90833, 90836, 90838." They don't say anything about same date of service, but we'll see how it goes!

Is that for LA medical psychologists? That is basically your problem. For my psychiatrists we are getting paid for the E/M and therapy codes.
: Re: BLUE CROSS BLUE SHIELD
: rdmoore2003 November 11, 2013, 05:13:30 PM
Thanks for all the advice! I just recently received an email from BCBS saying: "Effective January 1, 2014, BCBSLA will allow payment for E&M codes and the following psychotherapy codes when billed on the same claim: CPT codes 90833, 90836, 90838." They don't say anything about same date of service, but we'll see how it goes!

as of 2013, blue cross is doing the following for medical psychologists:
if you bill  99213 and 90833, blue cross allows 0 for the 99213 and is paying for the 90833.   

as of 2014, blue cross will pay for the 99213 & 90833- just the reimbursement for the 90833 will be much lower......(the lower reimbursement for the 90833 with an actual payment of the 99213 will equal out on both codes instead of just one code)