Medical Billing Forum

Billing => Billing => Topic started by: rachelkarim on March 10, 2016, 04:06:06 PM

Title: mental health billing modifiers
Post by: rachelkarim on March 10, 2016, 04:06:06 PM
Can we and should we be using mod 59 and 25 for 99213 and 90834 (or 90832) for commercial insurance for them to pay for them to pay 2 visits on same day?
Title: Re: mental health billing modifiers
Post by: kristin on March 10, 2016, 06:49:24 PM
The 59 modifier is only to be used on procedure codes, when two procedures or more are done during the same visit. I don't see how that would apply to your situation. The 25 modifier may be appropriate, depending on the circumstances. I don't do mental health billing, so I can't really say for sure.
Title: Re: mental health billing modifiers
Post by: Michele on March 11, 2016, 09:06:08 AM
What type of provider is it?
Title: Re: mental health billing modifiers
Post by: rdmoore2003 on March 11, 2016, 12:55:11 PM
I do mental health billing.  What type of provider is it?  Need more information.
Title: Re: mental health billing modifiers
Post by: NEWUSER on March 23, 2016, 10:23:55 AM
We have been using the 59 modifier for two sessions with different procedure codes on the same day - for instance, a 90834 and 90847.  We are strictly a mental health clinic.
Title: Re: mental health billing modifiers
Post by: Michele on March 24, 2016, 10:03:09 AM
We have been using the 59 modifier for two sessions with different procedure codes on the same day - for instance, a 90834 and 90847.  We are strictly a mental health clinic.

Just curious, do they allow both sessions when you do that? 
Title: Re: mental health billing modifiers
Post by: PMRNC on March 24, 2016, 05:31:42 PM
-59 would NOT be appropriate in that situation at all.

That is why you have the add on codes.



Title: Re: mental health billing modifiers
Post by: rdmoore2003 on March 30, 2016, 09:42:21 AM
We have been using the 59 modifier for two sessions with different procedure codes on the same day - for instance, a 90834 and 90847.  We are strictly a mental health clinic.


THIS IS INCORRECT!!!!!
Title: Re: mental health billing modifiers
Post by: PMRNC on April 04, 2016, 11:08:02 AM
Quote
THIS IS INCORRECT!!!!!

AGREE wholeheartedly, modifiers should not be used to increase reimbursement. Many mental health plans will not allow for two visits on the same day. There are add on codes that should be used in conjunction with the therapy codes. You cannot use a modifier for the purpose of being reimbursed for two sessions on one day.
Title: Re: mental health billing modifiers
Post by: Michele on April 06, 2016, 08:02:27 AM
The original poster still has not stated what type of provider this is.  That is kind of key to being able to answer.  Linda is correct, modifiers should never be used to increase reimbursement.  They should only be appended when the provider or a certified coder with access to the patient's records deems it appropriate.  Too often billers get caught up in "how do I get this paid?" and that can be dangerous.  Simply appending a modifier to get it paid may be fraud if the patient's records don't support the use of the modifier. 

You can bill for both the 90834 & 90847 but most insurances (definitely Medicare) do not allow both on the same date of service.  I have seen (once in 23 years) an insurance approve both codes because the patient lived in a rural area and had to drive two hours to get to the therapist office.  They approved both a family session and individual session on the same date due to those circumstances.