Medical Billing Forum
Billing => Billing => : Srsand May 12, 2021, 06:02:01 PM
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Hello all. I have a question and hope you all can help:
We have an insurance denying a prolonged therapy session that a clinical psychologist rendered. It was a 111 minute session. We billed a 90837 x 1 unit (53-89 minutes) with add-on code 99354 x 1 unit. Tricare is denying for "Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed". From what I can tell no modifier is needed. It was not a Telemed. Are they wanting the -HP? Or should we use -59 for this?
Thank you.
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I can tell you this, they do not want a 59 modifier. 59 modifiers are never appended to any E/M code. They are strictly for procedures.
As I don't do any type of mental health/BH billing, I am not familiar with the HP modifier.
But I would absolutely appeal this denial any way you can.
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I don't think the issue is a missing modifier. Add on codes don't require them. The 99354 is approved to use with the 90837 but they do not allow the first additional 1 - 29 minutes in addition to the 90837. Since it was a 111 minute session, the 99354 should be allowed, but TRICARE may not allow for additional time. I would recommend calling TRICARE to find out if it is a TRICARE exclusion, or if they require something indicating the amount of time spent.
Also, if this was a crisis you may want to consider using crisis codes 90839 and 90840.
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Okay. I'll have the denial called on for further reasoning. Thank you Kristin & Michelle! :)