Medical Billing Forum

Coding => Coding => Topic started by: autismyear on March 12, 2009, 02:35:00 PM

Title: Need help to code therapist work
Post by: autismyear on March 12, 2009, 02:35:00 PM
Hi -

Could someone help with how the following work would be coded?  Done by an LICSW - a child with disabilities is the patient/client, but family is at the session too learning how to work with him/her.

1.  Assessment - which right now involves:
-----1 hour observation at child's school, home or both to see behavior issues or other concerns.  These cannot be easily observed in the office.
-----1 hour report
-----1 hour meeting with parents only (child is not there for privacy while concerns are discussed).

Questions:  I know 90801 is the usual Psych tx interview code, but does it cover all of the above?  Is the observation hour at school covered, for example, or not because it is in a different location than Office?  Same with parent meeting without child there - can this be covered, and if so, does it go under 90801 or another code?  I heard it can't be included under 90801 because child is not there.

If so, how could the above be reasonably coded?

2.  90806 therapy session is a 50 minute session billed at $100.  Is there a way to code if it goes 15 minutes or 1/2 hour over?

3.  Regarding consistency of "price for a particular code" - Does the price always have to be the same?

Two examples:

3.1  There are two situations in which the 90808 might be used right now:

---one is a special service which is more intensive and is billed at $160 for 75 minutes to 1 1/2 hrs.

---the other is when a 90806 runs over as above.  But since calculating the 90806 extra time at $100 an hour would yield a different price, is this OK to have 2 different prices for the same code?  They really are 2 different services at different prices.

3.2  Similarly, social workers are asked to try to accommodate people, and negotiate fees down on a sliding scale if needed.  But that would mean for one client the 90806 might be charged at the normal $100 fee, and for another client but same insurance company, the client might be charged $70, so for that client's insurance claims should 90806 be charged at $70?  Will that seem wrong to have 2 different prices coming in for the same code but different clients?

Thank you for any help you can give. 
Title: Re: Need help to code therapist work
Post by: Michele on March 12, 2009, 06:51:37 PM
   I will try to help, but you've loaded this with many questions!   :)

Anyway, my first thought is that you could bill the hr meeting with the parents as a 90846, which specifies that the patient isn't present. 

There is also a code, 99080, for report preparation, the problem is most carriers do not reimburse for it.

The 90806 by definition is 45-50 minutes and the 90808 is 75-80 minutes so if the 90806 goes 15 minutes over the session it by definition becomes a 90808.  There isn't a code for a more intensive session, it just is specified by time spent. 

It is ok to have a sliding scale as long as it is available to all patients.  Most of the practices I am familiar with charge the insurance companies the same fee and apply the fee schedule if the patient doesn't have insurance or if they are out of network. 

Hopefully we will get some other opinions on this as well.