Medical Billing Forum

Coding => Coding => Topic started by: rdmoore2003 on January 31, 2011, 12:02:35 PM

Title: verifications
Post by: rdmoore2003 on January 31, 2011, 12:02:35 PM
OK.... my medical psychologist received information and I think it is incorrect.   The discription of 90804 is individual psychotherapy 20-30 minutes.    He was told that if he sees a pt. for even 15 or 17 minutes,,,,that he can use this code.   Is this true?   I am a licensed coder and have always went by the "book"  especially going by the descriptions of every code used.   If this is infact true, where can I get back up information on this in case of future audits?    Common sense tells me NO.  If it were true, discriptions would not be needed.   Would this be considered up charging?  Please help!
Title: Re: verifications
Post by: PMRNC on January 31, 2011, 12:19:19 PM
Well yes he can..there is no CPT for less than 10 min...HOWEVER it should not be done routinely because the interpretation of the CPT codes for therapy are designed to levels of plain English he needs to step up his time to accommodate the CPT code since there really is no code for it and technically he might be in trouble with an audit if this is found to be done frequently.. because.. he's not rendering services in conjunction with the CPT code he's using.  If there is a documented reason he is not using a full session to accommodate the 90804, that's a different story. For example, some patients don't have time to stick around for 20-30 min, so it is acceptable to bill the 90804 but document the reason for the shortened procedure.  I have had this come up and some carriers tell you to used modifier -53 (don't quote me on the exact modifier it's either -52 or -53) Reduced services. What the carrier does not tell you is that those claims will automatically get reviewed if filed electronically, file them on paper and be sure the file documents exactly why the visit was shortened.  I guess bottom line is if there is NO good reason to reduce the time, then there's a problem, and this should NOT be done routinely. Oh and one more thing.. the fee should NOT be a standard fee for a full 20-30 min session.
Title: Re: verifications
Post by: rdmoore2003 on February 02, 2011, 01:53:02 PM
ok  thanks alot for the information.  I am genuinely trying to make sure he does not do this at all.