Medical Billing Forum

Coding => Coding => Topic started by: mhbilling3355 on June 18, 2008, 11:46:52 AM

Title: EMDR coding
Post by: mhbilling3355 on June 18, 2008, 11:46:52 AM
I bill for several independent therapists, some of whom do EMDR.  Some of them use 90812, others use 90806.  One of them said a forum she visited said using 90812 could be considered fraudulent.  However, I've also read an article that says doing EMDR and billing it as a 90806 is grounds for an insurer to ask for their money back.

Does anyone out there have any information on the correct way to do this?  Based on the description, it would seem that 90812 is the more correct code.

Thanks much!
Title: Re: EMDR coding
Post by: Michele on June 19, 2008, 12:48:51 PM

   This is a gray area since there is no specific code for EMDR therapy.  I agree with you that 90812 does best describe the treatment  "...or other mechanisms of non-verbal communication...".  I'm not familiar with the forum that states that 90812 could be considered fraudulent.  You have to be careful with info on the internet.  Anyone can comment on a forum and they may not even state where they got their info.

   Of course this is also a forum, so you still need to be careful.  However I did do a little research.  I found that BCBS in many states recommends billing 90806 for EMDR.  I bill for many mental health providers myself and feel that either 90806 or 90812 are appropriate, however I would lean towards the 90812.  As long as all other aspects of the description of the code are met (time, 45-50 minutes, face to face in an office setting) then I don't believe that it could be considered fraudulent.  Just make sure the provider keeps a good patient chart.

   Insurance carriers are looking for the providers who are billing for patients that are not being seen, or for phone sessions being billed as face to face, etc..

Good luck