Author Topic: Need Help with a Modifier Issue  (Read 549 times)

adaniels5244

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Need Help with a Modifier Issue
« on: October 06, 2016, 11:00:56 AM »
BCBS of Horizon NJ is requesting we bill a CPT Code of 90887 and a CPT code of 90834 together on one claim with the appropriate Modifier.  Does anyone know what Modifier to use?  I normally split these codes but they were done on the same day.  Thanks for your help

Michele

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Re: Need Help with a Modifier Issue
« Reply #1 on: October 06, 2016, 12:32:31 PM »
I'm not familiar with any modifier that would be appropriate for those two codes however I am not a certified coder.  The only thing I can think of is the 25 modifier but that is for E/M codes, not MH codes.  Of course you would never just add the modifier to get the services covered.  You need to make sure that the services warrant the modifier.  With that being said, if the 90887 was completely independent from the 90834 you could try the 25 modifier.  I'm just not aware of any other one. 
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PMRNC

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Re: Need Help with a Modifier Issue
« Reply #2 on: October 07, 2016, 07:22:56 AM »
You don't indicate what testing was done to provide the 90887. 90887 is a consultation to interpret and discuss "results" of psychiatric or other medical examinations and procedures."   Your CPT 90834 is psychotherapy (face to face) and your 90887 is not face-to face. Medicare wouldn't pay the 90887, so most likely BCBS won't either.

Since they were both done same day but one has not much to do with the other, it's not likely to be paid with or without a modifier unless you have a specific E/M code to which would substantiate the 90887.

 And to note.. don't let the insurance companies tell you how to bill.. they are not supposed to, they can make suggestions but the bottom line is you need to bill as per the documentation.
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