evaluation insurance billing question?

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Alexis Conason

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Mar 10, 2015, 10:53:19 AM3/10/15
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Has anyone tried to bill insurance (Aetna) for 2 sessions of 90791 for a bariatric evaluation? 

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Alexis Conason, Psy.D.
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David Mahony

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Mar 10, 2015, 10:57:22 AM3/10/15
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I bill for one 90791 and three hours of 96101..sometime you need preauthorization


David Mahony, Ph.D., ABPP
Clinical Psychologist

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Corrales, Arturo

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Mar 10, 2015, 11:30:22 AM3/10/15
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David,

Is that for all evals?

 

I ask, because little by little, I am making the transition into private practice and am looking to maximize my billing…as I think we all are. Currently, in the hospital setting, I provide a clinical interview/observation (90791), and will only bill 96101 (few cases) if I have completed an MBMD with the pt – which has increased recently as I now have a student working with me. Some have suggested I move to a more rapidly administered and less involved scale (i.e. BDI/BAI/ BDD Questionnaire) so that I can include the scales in all evaluations and thus be able to bill for psych testing more often.

 

Arturo Corrales, Psy.D.

Licensed Clinical Psychologist

Department of Bariatric Surgery

 

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Ilana Breslau

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Mar 10, 2015, 11:44:20 AM3/10/15
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You can bill 90791 sequentially (2 separate visits) and be reimbursed but didn't think it's a code you can bill at a quantity of 2 for one session.

Re. 96101- I'd just make sure you can justify billing more than 1 hour of it in terms of how long it takes to score and interpret tests. Aetna does reimburse for more than 1 unit of this code
 
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Ilana Breslau PhD
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From: "Corrales, Arturo" <Arturo....@NBHN.NET>
To: NYC Bariatrics Group <nycbar...@googlegroups.com>
Sent: Tuesday, March 10, 2015 11:30 AM
Subject: RE: evaluation insurance billing question?

David Mahony

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Mar 10, 2015, 12:15:54 PM3/10/15
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96101 is for all psych testing, interpretation, report writing etc. I usually charge for 3 hours in addition to 90791. Most insurances cover this although some require preach. I use the PsyBari. It takes about a half hour to administer, score and interpret.

David Mahony, Ph.D., ABPP
Clinical Psychologist

Alexis Conason

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Mar 12, 2015, 4:43:29 PM3/12/15
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I'm also wondering if anyone has experience using the new interactive complexity add-on codes? It seems like these codes are applicable if there is 3rd party involvement (the examples given on APA are schools or probation officer). I'm wondering if involvement with the surgeon/nutritionist/PA would fall into this category? For example, I just completed an evaluation that required a 30 minute phone call with the nutritionist at the surgeon's office to share some concerns and develop recommendations to get the patient ready for surgery. 

Alexis Conason

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Mar 27, 2015, 9:49:52 AM3/27/15
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As a follow-up for anyone who may be interested: I researched a bit online about the Interactive Complexity add-on code and it seemed like it was appropriate for the complicated evaluation that I had done requiring a lot of coordination with the surgery staff. Aetna did reimburse for the code. How much? Wait for it…a whopping $3.82. 

Ilana

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Mar 27, 2015, 4:13:49 PM3/27/15
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Guess you're not planning an early retirement on those rates :)

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Julie Kolzet, PhD

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Mar 27, 2015, 4:38:51 PM3/27/15
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David,

Do you bill for three hours of testing? So, 96101 x 3 for the same date? I am not in network w Aetna rather Cigna. Whenever I have a new patient I bill for 90791 and 96101. I use the BDI and the BAI, along with others which tend to be patient specific. I am confused as to how one can indicate amount of hours worked on an insurance reimbursement form. Please advise. Thanks.

Julie Kolzet, Ph.D.
Licensed Psychologist 


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Julie Kolzet, PhD

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Mar 27, 2015, 4:46:47 PM3/27/15
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I have had no problem w reimbursement when I've used the add on code, 90785, in conjunction w 90834 or 90837. Can't say if this holds true when it's used in conjunction w 90791. Fyi. Biofeedback, 90901, is NOT covered by most insurance companies. This is frustrating for a few reasons. My contract w Cigna offers a code for this treatment method which suggested to me that it was a covered service, for one reason. I tried to use it for a patient and then I learned that the patient received a call from the insurance company about some free wellness program available through he insurance. That's all I have on this "program."


Julie Kolzet, Ph.D.
Licensed Psychologist 


~Kindly remember that I cannot guarantee the security of private information that we exchange by email, and that I may not check this email every day.  For any sensitive, detailed or urgent communication, I recommend contacting me by phone at 646-481-5619. Thank you.

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Julie Kolzet, PhD

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Mar 27, 2015, 4:47:42 PM3/27/15
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Cigna offers $3.40! 


Julie Kolzet, Ph.D.
Licensed Psychologist 


~Kindly remember that I cannot guarantee the security of private information that we exchange by email, and that I may not check this email every day.  For any sensitive, detailed or urgent communication, I recommend contacting me by phone at 646-481-5619. Thank you.

~This email (and any attachment) is only intended for the use of the person or entity to which it is addressed, and may contain information that is privileged and confidential. You, the recipient, are obligated to maintain it in a safe, secure and confidential manner. Unauthorized redisclosure or failure to maintain confidentiality may subject you to federal and state penalties. If you are not the intended recipient, please immediately notify me by return email, and delete this message from your computer.

David Mahony

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Mar 27, 2015, 7:20:24 PM3/27/15
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I have had success billing for three hours of testing. That usually covers all of my time. I'm not on Aetna but most others pay. 

David
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