Billing group speech therapy code and individual speech therapy code in same day

[karengeorge6]

Quick question-when we bill the individual speech therapy code 92507 and the speech group code 92508 together both with the 59 modifier, only the group code is paid and the denial reason for the individual sessions says "service is incidental or mutually exclusive to the primary procedure"

The services are provided at different times throughout the same day.


My question to you- How do we bill them to show they are mutually exclusive sessions so we will be reimbursed for both sessions that occurred? Is there a specific modifier to use other than 59?

[Michele]

There is really nothing else you can do when submitting the claim.  You can try to appeal with notes showing they were completely separate sessions at completely different times during the day, however the plan may just not allow for both to be done on the same day.