Psych - 2 visits in one day

[TerriTye]

I have a provider who is seeing a patient twice a day. It is a 90834. Can that be billed? Do you bill as two units? Won't that deny?

[PMRNC]

I have a provider who is seeing a patient twice a day. It is a 90834. Can that be billed? Do you bill as two units? Won't that deny?

No, I don't know any carrier who would pay on two visits in same day.   Why are they seeing them in 2 sessions?

[TerriTye]

I'm not sure. I'm going to check on that. I was pretty sure it could not be billed that way...just wanted to make sure. Thanks!

[Michele]

Well, actually I have heard of a case where the provider saw the patient in the a.m. and then again in the p.m.  Patient was in crisis but didn't need to be hospitalized.  You can bill but most likely insurance will not allow.  Second one will be denied as a duplicate and then you can appeal.  However, there is no guarantee that they will cover both visits.  In fact, I would bet they wouldn't.  The previous case was not one of my providers, I just heard about it so I don't know the outcome.

[PMRNC]

I was going by her statement:

I have a provider who is seeing a patient twice a day. It is a 90834. Can that be billed? Do you bill as two units? Won't that deny?

I took that to mean it was more than a "crisis" also remember there are new crisis management codes which would apply if this was out of the norm and met the requirements.

I'm 99.9% sure no carrier is going to pay for two a day.. I'd have to see the EOB to prove they paid it to believe it.

[debfini]

If the provider is seeing the client for 2 hours and thinks well that is (2) 90834 - WRONG!

I bill for an LPC, however, she does not take insurance.  I provide the statement.  She works alot with children/adolescents and will usually see the client for an hour and will then meet with the parents.  This may happen on the initial and during course of tx.  On the initial, I bill 90791 for first hour and then bill 90846 for second hour/same day.  During course of tx, I bill 90834 for 1st hour and then 90846 or 47 for second hour.

This came from    http://www.apapracticecentral.org/reimbursement/billing/2013-psychotherapy-codes.aspx - "When billing a private insurer that does not require authorization for 90837 and has not indicated that this code should be used infrequently, you should bill this code if your session time falls into the 53-minute or more time frame that pertains to 90837. We recommend, however, that you record your exact session start and stop times in your clinical note (for example, 1:02 to 1:57) when billing the new codes, as Medicare providers must do. At any point, a company can ask you for appropriate documentation or explanations. Also be mindful that if you have historically billed a company primarily the 45-50 minute code and switch to primarily using the new 60-minute code, that company may ask you to explain this change."

Hope that helps....

Debbie
Billing Solutions for Therapists
703-729-6320

I have a great Psychotherapy Coding Algorithm that may be helpful.  Let me know your email address and I can send to you.

[PMRNC]

Great info deb.. this really does come down to common sense.. meeting with kids then parents is very different from seeing "A" patient twice a day.   That is a matter of convenience NOT medical necessity.. a once or twice shot maybe.. but I took it to be that this was a reoccurring situation.
IF you are billing ONE patient twice a day your DOS isn't changing.. NO carrier is paying for it. Patient wants to pay.. great.  life is good. There's no WAY a carrier would approve two sessions in ONE day.. you can bill for the time periods allowed.. even take a break..but your not getting paid for two separate sessions in one day.

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