Author Topic: BLUE CROSS BLUE SHIELD  (Read 11102 times)

rdmoore2003

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BLUE CROSS BLUE SHIELD
« on: January 15, 2013, 10:22:39 AM »
has anyone received payments from blue cross blue shield for medication visits with a medical psychologist yet?

I billed a 90863 with add on therapy code and we are being reimbursed for therapy code and not med check.  of course bcbs does not know how they are to process and the reimbursement for the therapy code is higher than the allowed amount for the 90863...
Regina

PMRNC

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Re: BLUE CROSS BLUE SHIELD
« Reply #1 on: January 15, 2013, 12:35:33 PM »
Even though the new codes do account for prescribing psychologists, only those in NM and LA are being considered according to scope of license restrictions in those states.   IN New Mexico and Louisiana a 90863 has to be used with either 90832, 90834 or 90837.   
Linda Walker
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rdmoore2003

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Re: BLUE CROSS BLUE SHIELD
« Reply #2 on: January 15, 2013, 01:56:28 PM »
Even though the new codes do account for prescribing psychologists, only those in NM and LA are being considered according to scope of license restrictions in those states.   IN New Mexico and Louisiana a 90863 has to be used with either 90832, 90834 or 90837.

this is exactly how I coded it.   blue cross is paying only the therapy code and not the 90863 code...
Regina

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Re: BLUE CROSS BLUE SHIELD
« Reply #3 on: January 15, 2013, 02:57:35 PM »
Quote
this is exactly how I coded it.   blue cross is paying only the therapy code and not the 90863 code...

Right but are you in NM or LA? If not that's why.
Linda Walker
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rdmoore2003

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Re: BLUE CROSS BLUE SHIELD
« Reply #4 on: January 15, 2013, 03:16:30 PM »
Quote
this is exactly how I coded it.   blue cross is paying only the therapy code and not the 90863 code...

Right but are you in NM or LA? If not that's why.

Yes, I am in LA.
Regina

rdmoore2003

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Re: BLUE CROSS BLUE SHIELD
« Reply #5 on: January 15, 2013, 03:19:31 PM »
I coded 90863 on line 1 and 90832 on line 2.   they paid 90832 but did not for 90863 with denial of:  N01- Procedure is Integral to another procedure.
Regina

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Re: BLUE CROSS BLUE SHIELD
« Reply #6 on: January 15, 2013, 03:29:39 PM »
Ok, this is from notes I took at a webinar:

A CPT code of 90863 (ADD ON CODE) was added for PRESCRIBING psychologists only.   90863 - Pharmacologic Management, including prescription and review of medication WHEN PERFORMED WITH PSYCHOTHERAPY SERVICES Do NOT report 90863 If already reporting an E/M service and add on psychotherapy code 90833, 90836 or 90838

So I'm thinking you need the appropriate E/M and the 90863 is your Add on
Linda Walker
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rdmoore2003

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Re: BLUE CROSS BLUE SHIELD
« Reply #7 on: January 16, 2013, 09:24:26 AM »
ok lets try that...thanks linda
Regina

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Re: BLUE CROSS BLUE SHIELD
« Reply #8 on: January 16, 2013, 03:37:04 PM »
Your welcome.. let me/us know what happens :)
Linda Walker
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rdmoore2003

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Re: BLUE CROSS BLUE SHIELD
« Reply #9 on: January 18, 2013, 10:58:31 AM »
my medical psychologists' board has found out that blue cross is not accepting the add on codes.  basically, he is to use e/m code only.
Regina

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Re: BLUE CROSS BLUE SHIELD
« Reply #10 on: January 18, 2013, 11:09:52 AM »

Quote
my medical psychologists' board has found out that blue cross is not accepting the add on codes.  basically, he is to use e/m code only.

We've not had any problem with BCBS over new codes at all. In fact our BCBS announced in a letter that the old codes would be denied. If I were you, I would request an agent to guide you to documentation to show they are not accepting the new codes and I would find out what THEY intend to do about it since it is mandatory to use as of 1/1/2013.  Lowering your reimbursement and only accepting DELETED or OLD codes would be completely unacceptable to me.
Linda Walker
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www.billerswebsite.com

rdmoore2003

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Re: BLUE CROSS BLUE SHIELD
« Reply #11 on: January 18, 2013, 01:14:46 PM »
blue cross is not having my medical psychologist use old codes.   we are new to the e/m codes and yes we do have documentation that shows that they will not cover a "medication visit w/therapy"   Documentation shows that he must do 1 or the other per day. 
Regina

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Re: BLUE CROSS BLUE SHIELD
« Reply #12 on: January 18, 2013, 01:18:26 PM »
Quote
blue cross is not having my medical psychologist use old codes.   we are new to the e/m codes and yes we do have documentation that shows that they will not cover a "medication visit w/therapy"   Documentation shows that he must do 1 or the other per day. 

Ahhh ok, that's a bit different than saying they won't cover the new codes.
Linda Walker
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www.billerswebsite.com

rdmoore2003

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Re: BLUE CROSS BLUE SHIELD
« Reply #13 on: January 22, 2013, 04:31:22 PM »
Quote
blue cross is not having my medical psychologist use old codes.   we are new to the e/m codes and yes we do have documentation that shows that they will not cover a "medication visit w/therapy"   Documentation shows that he must do 1 or the other per day. 

Ahhh ok, that's a bit different than saying they won't cover the new codes.

BLUE CROSS IS NOT COVERING THE NEW CODES AS 90863, 90833, 90836 ETC FOR MEDICAL PSYCHOLOGISTS
Regina

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Re: BLUE CROSS BLUE SHIELD
« Reply #14 on: January 22, 2013, 05:08:37 PM »
Quote
BLUE CROSS IS NOT COVERING THE NEW CODES AS 90863, 90833, 90836 ETC FOR MEDICAL PSYCHOLOGISTS

Right, it's a scope of licensure denial of services for that scope of license of that provider. I just was clarifying that it was NOT an issue of the carrier NOT acknowledging the new codes over the old. 
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com