Recently a clinician told\u00a0us that providers had been audited for the use of 90837. The CPT codes have a duration associated with them and if\u00a0the notes and the duration meet the criteria there is no reason for insurance companies to audit\u00a0or for you to be afraid of utilizing that code. Most sessions go longer than 45 minutes, which is the CPT definition of 90834, and although in the crosswalks provided, back in 2013 they said that 90806 translated to 90834 they were incorrect.\u00a0 The 90808 was supposed to translate to 90837 however, the 90808-code definition was 75 minutes or longer which does not equate.<\/p>\n
The APA put out a guideline some time back\u00a0regarding the durations for 90832, 90834 and 90837. Here is the guideline as proposed by the APA:<\/p>\n
16-37 minutes use 90832<\/p>\n
38-52 minutes use 90834<\/p>\n
53 or more use 90837<\/p>\n
In addition there\u00a0are at least two insurance companies that\u00a0we know of that do not allow the 90837 unless an authorization is obtained.\u00a0 They are Optima\/Sentara out of Virginia and Optum\/United Behavioral.\u00a0\u00a0 After some research\u00a0we noted that Optima had a published\u00a0 allowable for 90837 which makes one wonder if this rule has been relaxed.\u00a0\u00a0\u00a0 (The original rule was regarding the 90808 code for Optima\/Sentara<\/em>. )<\/p>\n For a fact the Blues in most all states allow the 90837 as does Medicare no questions asked.\u00a0 Most of the insurances we have dealt with through the years do allow this code and there is no specific criteria or red flags.\u00a0 This makes\u00a0us wonder if those folks that were being audited also had some other item in their billing that set off red flags with the insurance industry.<\/p>\n Word of caution<\/strong> for all providers you should always ensure that the documentation matches what\u00a0was billed.\u00a0 So whether using an Electronic Health Record or some sort of manual system this is as important as the records\u00a0maintained for the IRS. Keeping these records in synch provides\u00a0the best method for keeping your practice ethical and out of arms way for those auditors.<\/p>\n .<\/p>\n","protected":false},"excerpt":{"rendered":" Recently a clinician told\u00a0us that providers had been audited for the use of 90837. The CPT codes have a duration […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[4],"tags":[],"class_list":["post-294","post","type-post","status-publish","format-standard","hentry","category-billing"],"yoast_head":"\n