Medical Billing Forum

Coding => Coding => Topic started by: laceyx08 on January 11, 2013, 03:51:18 PM

Title: 90 minute session
Post by: laceyx08 on January 11, 2013, 03:51:18 PM
Hi I was wondering if someone could tell me how to bill a 90 minute session with a psychologist? thanks.
Title: Re: 90 minute session
Post by: rdmoore2003 on January 14, 2013, 05:01:00 PM
i have had a couple of webinars and a webinar with my program software.   we have been told that with the new codes, that basically that your mind frame must think the following:
16-60 minutes -you get paid.   anything below or over you do not.  with the exception of 90839 and you must document the qualifications for this code to fall as a crisis. 
Has anyone heard any different?    other than the webinars, we have also been told this thru our states Psychology board and employee of DHH.
Title: Re: 90 minute session
Post by: Barbara Griswold, LMFT on January 15, 2013, 01:31:37 AM
This is how I answered that question in my Special Report: The 2013 CPT Codes -- What Every Therapist Needs to Know (available at order page) :  Be aware that sessions of this length may only be reimbursed with preauthorization and for special circumstances. So, bottom line -- If the session meets the criteria for a crisis session, you might use these new cirisis codes (check if authorization is needed -- believe it or not, it sometimes is). If not a crisis, you may either 1) use the 60 minute therapy code or prolonged services codes for all sessions longer than 52 minutes, knowing that you may need preauthorization, or 2) bill one 45 or 60 minute session to insurance and contract privately with the client to pay any additional time out of pocket (have them agree to in writing). If itís a Medicare client, you have to have the client sign an Advance Beneficiary Notice.  In addition to the psychotherapy code for 60 minutes and above (90837), there are codes 99354 (60 minutes Prolonged Services) and 99355 (Prolonged Services, each additional 30 minutes) which can be used by all licensed professionals, but it seems these might be designed for use when a scheduled session unexpectantly goes way overtime -- also, reimbursement as always is subject to the planís rules and reimbursement policies (see the AMA Errata published December 12, 2012 for more on these codes). Bottom line:  call the plan to see if they reimburse for those codes or if preauth is needed before billing them.

Barbara Griswold, MFT
Author, Navigating the Insurance Maze -- The Therapist's Complete Guide
Title: Re: 90 minute session
Post by: rdmoore2003 on January 15, 2013, 10:19:49 AM
You may want to make a note of the additional descriptions of the new codes:
90832- 16-37 minutes
90834- 38-52 minutes
90837-53-60 minutes
Title: Re: 90 minute session
Post by: PMRNC on January 15, 2013, 12:37:05 PM
For 2013 the the 15 minute rule will apply for determining how to choose the appropriate code based on time spent, If the time spent falls outside of the exact description.