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mental health billing modifiers

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Michele:

--- Quote from: NEWUSER on March 23, 2016, 01:23:55 PM ---We have been using the 59 modifier for two sessions with different procedure codes on the same day - for instance, a 90834 and 90847.  We are strictly a mental health clinic.

--- End quote ---

Just curious, do they allow both sessions when you do that? 

PMRNC:
-59 would NOT be appropriate in that situation at all.

That is why you have the add on codes.

rdmoore2003:

--- Quote from: NEWUSER on March 23, 2016, 01:23:55 PM ---We have been using the 59 modifier for two sessions with different procedure codes on the same day - for instance, a 90834 and 90847.  We are strictly a mental health clinic.

--- End quote ---


THIS IS INCORRECT!!!!!

PMRNC:

--- Quote ---THIS IS INCORRECT!!!!!

--- End quote ---

AGREE wholeheartedly, modifiers should not be used to increase reimbursement. Many mental health plans will not allow for two visits on the same day. There are add on codes that should be used in conjunction with the therapy codes. You cannot use a modifier for the purpose of being reimbursed for two sessions on one day.

Michele:
The original poster still has not stated what type of provider this is.  That is kind of key to being able to answer.  Linda is correct, modifiers should never be used to increase reimbursement.  They should only be appended when the provider or a certified coder with access to the patient's records deems it appropriate.  Too often billers get caught up in "how do I get this paid?" and that can be dangerous.  Simply appending a modifier to get it paid may be fraud if the patient's records don't support the use of the modifier. 

You can bill for both the 90834 & 90847 but most insurances (definitely Medicare) do not allow both on the same date of service.  I have seen (once in 23 years) an insurance approve both codes because the patient lived in a rural area and had to drive two hours to get to the therapist office.  They approved both a family session and individual session on the same date due to those circumstances.

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