Billing > Billing

new mental health billing codes-25 modifier need?

(1/6) > >>

James B:
I just got all of January's billing out about 10 days ago and am eager to see how the different payers are reimbursing the new codes. Some problems were anticipated, naturally. I've run into my first one:

Anthem told a colleague yesterday that we need to use a 25 modifier when a 99214(modifier applies to this code) is billed along with a 90836. In this case, they actually paid the full amount for all the 99214s I had billed for this patient in Jan but ignored the 90836's that were part of those same appointments. My colleague is telling me to use the 25 modifier whenever an add-on code(99212,99213,99214, etc.) is billed along with a psychotherapy code(90833,90836).

However, it appears that Cigna just paid on a similar claim where no modifier had been used. They paid on both codes. 

Help, please? Is this going to vary depending on the insurer? Should I just use the 25 modifier(except for Medicare) to be safe?

Thanks!

James

PMRNC:
I don't believe you can just arbitrarily assign a modifier if it's not required/necessary unless documentation is required.  I have a tips booklet with tips on modifiers and for -25 it says:

– -25 Significant separately identifiable E/M service by the
same physician on the same day.

– When a physician must provide a separate and identifiable E/M
service on the same day as a procedure or another service,
modifier 25 is appended to the E/M code.

– Both the E/M service and the other service or procedure require
individual documentation, although this documentation may be
within the same written note

TIP

– Ask yourself: “Would a separate visit have been needed to
take care of the problem? Does my documentation (hx,PE,
MDM and/or time) support a separate service?”
Modifier

rdmoore2003:
I was told by insurance companies and DHH that with the add on codes- no modifiers are required.  I havent had issues with any except Blue Cross Blue Shield.  They are not wanting E/M with therapy add on (90832, 90834 & 90837).   We are waiting to see if they actually cover the E/M with medication add on (90833, 90836, & 90837)

James B:

--- Quote from: rdmoore2003 on February 27, 2013, 06:41:14 PM ---I was told by insurance companies and DHH that with the add on codes- no modifiers are required.  I haven't had issues with any except Blue Cross Blue Shield.  They are not wanting E/M with therapy add on (90832, 90834 & 90837).   We are waiting to see if they actually cover the E/M with medication add on (90833, 90836, & 90837)

--- End quote ---

This has been our experience, exactly, so far. I'm sure BC/BS is behind close doors figuring out how not to pay psychiatrists, especially OON doctors like us. 90832, 90347, 90837 are for with therapy without E/M.

rdmoore2003:

--- Quote from: rdmoore2003 on February 27, 2013, 06:41:14 PM --- I havent had issues with any except Blue Cross Blue Shield.  They are not wanting E/M with therapy add on (90832, 90834 & 90837).   We are waiting to see if they actually cover the E/M with medication add on (90833, 90836, & 90837)

--- End quote ---

BCBS is reimbursing the E/M + 90833, 90836, & 90838

Navigation

[0] Message Index

[#] Next page