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CPT Coding Changes

1.  Confused

Posted Mar 12, 2013 5:10 PM

I don't know if anyone else is having this problem but I am finding the insurance companies are not paying on CPT code 90863
What to do???????
Also i am finding each insurance company  is paying diff for the codes
and some only use certain codes
Laura W.
Sherry G.

(631) 569-2387


2.  RE:Confused

Posted Mar 13, 2013 8:37 AM
I have had the luxury until now to work in a cash clinic not responsible for any financials. I just accepted a position in TX a state requiring delegated authority. They have no idea what to do with these changes and I am working at a PHP and split office time on a contracted split percent of reimbursables. If I don't get a handle on this I will not get paid at all. So I need to become a billing expert overnight. Any suggestions on one stop shopping for a cross walk to bring me from zero to 100 in a second and then I can keep up. I read the postings and it appears to be a quagmire. Any assistance greatly appreciated. Arlene

Arlene Emery
Spring TX
(361) 676-9975


3.  RE:Confused

Posted Mar 14, 2013 8:01 PM
I don't think this code exists anymore. You will have to utilize the 99213 to 99215 series (at least for established patients) Regards Lynn ------------------------------------------- ----------------------------------------- Lynn McClellan Business Owner Mattoon IL (217) 273-3226 ----------------------------------------- -------------------------------------------

4.  RE:Confused

Posted Mar 15, 2013 2:12 AM
I am not having any problems with the codes for add on therapy, but you do have to add a modifier to the HICFA. The modifier 25 lets insurance companies know to pay for the two billing codes in one day. I am pleased that in every case in Maine where I practice PMHNP are getting paid more than previously. I really recommend for questions the APNA trainings were good, but the best thing that I did was buy the CPT code 2013 book. It is very detailed and clear in regards to coding, examples, and documentation. ------------------------------------------- ----------------------------------------- Naomi Brown Aquila Mental Health Services Orrington ME (207) 992-6269 ----------------------------------------- -------------------------------------------

5.  RE:Confused

Posted Mar 16, 2013 12:36 PM
Naomi,  I agree i use the 99's and the add on psychotherapies because 99.9% of my patients are not only medication management but also psychotherapy.  I agree with this way of billing the reimbursement is definitely more lucrative here in Illinois than before. Which it should be because of all the work we put into care.  Regards Lynn

Lynn McClellan
Business Owner
Mattoon IL
(217) 273-3226


6.  RE:Confused

Posted Mar 23, 2013 4:38 AM
------------------------------------------- ----------------------------------------- Debbie Thomas EdD, APRN, PMHCNS- BC Associate Professor ULSON Owner private practice ----------------------------------------- -------------------------------------------

7.  RE:Confused

Posted Mar 24, 2013 10:36 AM
------------------------------------------- Cynthia Taylor Handrup, DNP, APN, PMHCNS-BC Psychotherapist Private Practice Chicago, IL ----------------------------------------- -------------------------------------------

8.  RE:Confused

Posted Mar 15, 2013 6:34 AM

The CPT code 90862 was indeed eliminated. CMS (Center for Medicar & Medicaid Services) required that there be a 90863 ONLY to be used by the handful of prescribing psychologists in 2 states.
So actually the insurance companies are correct in not reimbursing anyone else for this code.
There is an algorithm that was included in the APNA webinars that the AACAP (American Association of Child & Adolescent Psychiatry) graciously allowed everyone to use. It's very helpful to have at your desk, along with the definitions of the codes and what can and can't be combined. Hang in there....

Sandra Cadena
Walden University & Universidad Autonoma de Bucaramanga,South America
Florida, USA



9.  RE:Confused

Posted Mar 13, 2013 9:21 AM
Yes, we aare hearing this all around the country.  It would be interesting to see how a 99214 is paid for a primary care visit and compare with a psychiatric visit. I wonder if we can get that info from the state insurance commissioner?

Mary Moller
Associate Professor, Specialty Director-Psychiatric Nursing
Yale University School of Nursing
New Haven CT
(203) 389-4277


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