Forum - Questions & Answers

Dec 9th, 2014 - pvang 4 

Psychotherapy Coding

Hi there-

If patient had two psychotherapy sessions in one day, each with different amount of time, is it appropriate to bill for two codes: 90832 and 90834? Or is it appropriate instead to add up the number of units and bill the code with the higher time amount (90837)?
I can’t find anything on this.

According to one of the psychotherapy notes, it indicated that it was a group session however patient was the only participant so patient met individually with the provider (40 MINS)—they billed this session as an individual therapy 90834. The other session was an individual therapy session (25 MIN) and they billed 90832.

Any guidance/info is much appreciated. Thanks.

Dec 9th, 2014 - Kat31477 56 

re: Psychotherapy Coding

As long as the times are documented appropriately in the note, you can bill the code for the total amount of time spent that day. Psychologists can also bill the codes for prolonged services if the session extends beyond 90 minutes.

Dec 9th, 2014 - pvang 4 

re: Psychotherapy Coding

Thank you for responding to me.
To add to this, the CMS NCCI also have CPT® 98032 as bundled into 90834 with no mod allowed to override. How does this change the way how they should bill if notes are present to show that there were two different sessions?

Since one of the notes indicate that one of the session was a group therapy, but because the member was the only participant, they billed it as an individual session. Is this accurate as well?

Also can you provide me direct me to the source where it indicates that a prolong code is billable for sessions that extend beyond 90 minutes?

Sorry for more questions...just trying to understand this better. Thanks!

Dec 9th, 2014 - jvosfernea 66 

re: Psychotherapy Coding

I would also want to insure that BOTH of the sessions (group session and 1:1 session described) were conducted by the same therapist/psychologist, before I attempted to bill a longer code to include both sessions? I do not believe you will be able to 'group' the services into one bill if that is not the case. Also, be aware that, depending on the payor (and esp'ly with Medicaid), you may receive reimbursement for only one of the two sessions, unless both are accounted for on a single note. In MT (where I write this reply) only one therapy contact per day is allowed by most payor sources, and they typically pick the less expensive one to cover, (unless one has already made its way through their system in which case, the second to hit their computer is the one refused reimbursement). And that (again, in MT) unless the same provider was involved in the service provision of BOTH sessions, the two could not be combined.
I wasn't certain in how you wrote the scenario if this was the case (one vs. two providers involved), and am certainly open to hearing from someone more well versed than I, should there be dissent to what I've written?
Also, depending on your local/state contract, you may not receive reimbursement for any session which extends beyond a specified amount of time, regardless of the modifier used.
Do others have more info on this type of situation?



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