Medical Billing Forum

Coding => Coding => Topic started by: MCMS on April 07, 2009, 01:15:25 PM

Title: How to bill a 3 hour IOP group (90853) to insurance
Post by: MCMS on April 07, 2009, 01:15:25 PM
  I have been billing for 1 hour groups(90853) for a new chemical dependence office and they are now doing 3 hour groups 3 times a week.  Is there a modifier or another code to show they are now 3 hour groups and not 1 hour?  I tried to increase the units but it gets denied and only paid at the 1 hour rate. ???
Title: Re: How to bill a 3 hour IOP group (90853) to insurance
Post by: Michele on April 09, 2009, 07:09:57 AM
Since the CPT description doesn't specify a time frame the units would not be appropriate.  I'm not familiar with any way to bill a 3 hr session other than the 90853, but the allowed amount will always be low.  :(

Michele
Title: Re: How to bill a 3 hour IOP group (90853) to insurance
Post by: MCMS on April 09, 2009, 10:38:15 AM
Thanks for the input Michelle  :) We did find a modifier -U2 or -U3 to show 2 or 3 hours so we are going to give it a try since the insurance co. are no help.....  So I'll make sure to give an update if that works.
Thanks, what a great forum! ;D
MCMS
Title: Re: How to bill a 3 hour IOP group (90853) to insurance
Post by: Mystershyster on April 20, 2016, 03:24:05 PM
When billing IOP, you need to use a UB10 form and bill rev code 0906 with 3 units to be properly reimbursed for it. Most providers group IOP and inpatient claims in the same category and therefore request facility claims for IOP to be billed on UB10 - when they transition to regular outpatient though, you need to go back to using the CMS10 forms..