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LPC billing for School Observation with established client

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Hello everyone,

Need some help on this one as it almost never comes up.  I have an LPC I bill for that does NOT take insurance.  However, I need a correct CPT code to place on the statement for client's parents to submit to insurance.  The provider charges for transportation (DC/Metro area) and for 1 hour of observation where she literally sits in the back of the classroom for one hour and returns back to her office.

I am rather "glazed over" from googling this search.  There is plenty of info out there for physician/psychiatrist/psychologists etc to bill and use 90834 and add-on 90785, however, in the instance of a Licensed Professional Counselor, what would be the correct CPT code?

Thank you in advance for even reading this question and any help you may be able to provide....

Debbie Gilbert :-\

Debbie, some additional information would be useful.  These are rhetorical questions for you to consider.

At least until 2014, Medicare did not cover LPCs.  Have you verified that the insurance carrier involved in this particular situation covers the work of LPCs in your state?

For what purpose is your LPC sitting in the back of the classroom?  You use the word "observation".  Would that not then qualify this setting as evaluation and management, rather than therapy.

You mentioned the code 90834.  That code is to be used for a phsychotherapy session with the patient and/or a family member.  Is your LPC actually conducting a psychotherapy session by sitting in the back of the classroom and observing?

What would be an E/M code that would better describe what your LPC is actually doing?  Take a look at the codes in the first section at the top of this link.  If the insurance carrier involved in this situation covers LPCs, then the code relevant to this situation that a physician/psychiatrist/psychologists would use in your state and for this insurance carrier would also be valid for your LPC.  This link is for the state of Minnesota and may not be relevant for your state.  (Note that you can find 90834 on Page 2 of this link.)

For the sake of educating others passing by later, you might post back any solution you come up with.

I agree with RichardP.  You cannot use a 90834 unless you are actually doing therapy.  Also, depending on the family's insurance, you may have to get an out of network authorization due to the place of service.

Boy - both of you "nailed" it....I have (of course) have not sent the statement to the family yet for them to pay, however, what I did put was 90887 (school)  "Interpretation or explanation of results of psychiatric, other medical examinations and procedures, or other accumulated data to family or other responsible persons, or advising them how to assist patient for 45 min. as she met with family and school personnel and then 90785 Interactive Complexity - 60 she did observe the child in the classroom setting interacting with other children, etc. for an hour.  She will charge for transportation also - 1/2hr  to and 1/2hr  back to office. The insurance will probably ONLY pay for one of the three.(if they pay at all)  The transportation code is set up as an administrative code.

This therapist (LPC) typically works with young children and adolescents with behavior/mood, etc issues.  This particular therapist does NOT, nor has ever taken insurance (which is the case of approx. 65% of mental health professionals in the Washington D.C. Metro area).  That handout was extremely helpful.  Thank you. 

If anyone see some glaring problem with my response, please let me know before 12/31/15 as I will be sending this invoice out on this date or before.  Again, thank you for your responses.  I ALWAYS get an answer here and ALWAYS feel
 safe asking. 

Merry Christmas/Happy Holidays and Happy New Year everyone!

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