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IOP Billing - 180 minutes not reached.

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Yesi:
Thank you so much everyone!! Heidi, you have so much info to share! You've opened up some thoughts and new questions for me to think about. By the way the HCPC is H0015 for chemical dependency. I had billed some codes for services that were done and documented and we were paid, but I was not sure if there was a correct way of billing - for example could I use Mod 52?? I hope another IOP provider (chemical dependency) can chime in and give a little input - What are other providers doing in these cases?

Michele:

--- Quote from: Yesi on March 24, 2014, 09:34:01 PM --- What are other providers doing in these cases?

--- End quote ---

Are you still referring to someone leaving early for the IOP?

52 modifier is indicating reduced services.  Why are you saying the H0015 is a reduced service? 

I'm just not sure I understand completely what you are asking so I don't want to respond wrong.   :)

Yesi:
Hi, someone suggested using 52 w/ H0015 as a possibility but they were not sure.
Yes, I'm trying to figure out billing for someone leaving before finishing a 180 minute session. Thank you.

Michele:
Oh, ok.  I can see where that might be a possibility.  Since I am not a coder though, I really don't know the answer.  I'm hoping Heidi might be able to clear this up. 

Which is better?

1.  Bill for the service that was actually performed but not the service that was authorized?  90837

2.  Bill for the service that was authorized and was supposed to be performed and use the 52 modifier?  H0015

HeidiK:
Hello!

In my opinion, there are still a couple of unanswered questions in order to give specific advice. 

1. Are you billing on a CMS1500 or UB?  Provider based coding differs greatly from out-pt facilities just as it would differ from in-pt or acute care facilities.

2. If the facility is out-patient, what revenue code is being used?  Review of the carriers revenue code definitions would be necessary to be sure of accuracy.

I don't believe Modifier -52 would be appropriate.  Most carriers, including Medicare, will not recognize -52 on time based codes or E/M services.  This modifier is typically used for surgical procedures, such as a surgery which is stated in CPT to be bilateral and only one side is operated on or when the primary surgeon calls in another surgeon to manage another part of the procedure.  The second surgeon would use -52 to show he/she did not open or close the patient thus, his/her services were reduced for that procedure.

A conversation with the doctor or coder at your client's office or even a call to the specific carrier is the best way to clear this up.  The carrier will be able to review the patient's own policy guidelines and determine if a new authorization is needed or if the existing one can be modified. 

They will also be able to answer any questions about how they require coding and/or modifiers to be used.  Remember, proper billing and coding is not only determined by individual carriers but also by individual or group policy contracts the provider has agreed to.

Hope this helps lead to an answer for you!  :)

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