Good Morning!
I'll do my best to "weigh in" as Michelle put it - this is a complicated issue!
Basically, Regina is correct - documentation is always key to any service billed. Having an authorization however, poses a potential problem. If you request prior auth for one service and perform something else, you must call and revise that auth in order to guarantee payment (I use the word "guarantee" loosely - no authorization or verification of benefits is a "guarantee". Insurance companies cover themselves by saying "this is not a guarantee of coverage, payment will be decided based on claim submission). Bottom line, the service you did not authorize can potentially be denied for not having "prior auth".
My first question would be to ask if you are providing coding services for this client? If not, how do you know the required time was not provided? Is it your responsibility to offer guidance and instruction on proper coding or are you only responsible to submit claims based on the source document provided?
If you are coding, review the documentation and verify all components for the service are included based on the carrier guidelines you are submitting the claim to. You didn't state which IOP was performed - was it S9480 for Mental Health or H0015 for Chemical Dependency? H0015 is described as IOP for at least 3 hours per day, at least 3 times per week. Medicare will not cover either of these codes and many carriers will not recognize them either. The authorization issue comes up here as well, coding and billing instruction should be verified with the carrier when requesting authorization.
As far as psychiatric codes for this situation, they are basically split into three groups:
90791-90792 - Psychiatric Diagnostic Evaluation - For assessment or reassessment
90832-90838 - Psychotherapy - Includes ongoing assessment and adjustment of interventions
90839-90853 - Psychotherapy for Crisis - Urgent assessment and history of crisis state
CPT Coding guidelines offer many more details such as which require patient to be present, when an E/M can be billed in addition to etc. The guidelines also state times required for certain codes which is what I believe you are trying to verify:
90832 & 90833 - 16-37 min 90834 & 90836 - 38-52 min 90837 & 90838 - 53 min or more
The time specific codes listed above can be billed with a different "add-on code" 90785 for Interactive complexity which refers to "specific communication factors that complicate the delivery of a psychiatric procedure". This code is typically used when the patient is impaired, young or verbally undeveloped and have family members and/or other caregivers present for the session. It is not a time-based code.
The only code I could verify for extra time is 90840 which is an "add-on code" (meaning it cannot be billed by itself) for each additional 30 minutes when 90839 is billed. 90839 is defined as Psychotherapy for crisis; first 60 minutes. CPT codes for Psychotherapy for Crisis also state "even if the time spent on that date is not continuous" meaning the provider must calculate the total face-to-face time with the patient and/or family within a 24 hour calendar date. An example would be initial encounter with a suicidal patient for 90 minutes, then four hours later the provider returns for additional psychotherapy for 30 additional minutes - Coding on the bill would be 90839 and 90840 x2.
Clearly, this really is complicated! My interpretation is based on CPT guidelines and are not carrier or state specific so I would suggest a discussion with the provider or a certified coder experienced with the CPT Psychiatry Section. I also found a couple of links which might further help as well:
Medicare Coverage of Psychiatry
http://www.medicareadvocacy.org/medicare-info/medicare-coverage-of-mental-health-services/CPT Coding changes for Psychiatry - 2013
http://www.psych.org/cptcodingchangesHope this helps - at least a little!
Heidi Kollmorgen, CCS-P