Q&A cpt code question

[braveone]

I currently work for a facility that bills out IOP with 90853 with a 22 modifier, and REV code 906. When I look this up in CPT book . I do not see supporting documentation that 90853-22 is IOP it is group therapy. H0015 is specifically for IOP. Management indicates that the modifier 22 is what they use to indicate it is different from group. I do not agree with this at all. Would you be able to give me supporting documentation

Thank you,
braveone

 

[Laureen]

Hi braveone - thanks for stopping by. Can you define IOP? Intensive outpatient perhaps?

And yes 90853 is a group psychotherapy code.

H0015 is Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education

If you are indeed looking for intenstive outpatient code why can't you use the H code? Who is the payer? If Medicare I don't think they pay for substance abuse treatment. You should be able to bill their secondary however.

Bottom line - contact the payer and find out if it is covered and if so how do they want it coded. Best practice is to do that upfront and get an ABN signed up front.

 

[braveone]

Hi Laureen,
Thank you taking the time to answer my question.

Yes, IOP is intenstive outpatient. They do not bill Medicare, only commerical and Medical Assistance type plans.That is my question exactly why isn't the outpatient portion of the program billing with H0015 ? They answer me that is the way it has always been billed as 90853 with a 22 modifier. I explained to them that modifier 22 does not support 90853 to bill as an IOP.

My next question to you is; am I in violation of correct billing if I continue to do it "their" way?

I do not enter the codes, and I am not sure who does at this point. I am only on a temporay assignment , so I do not know much about the outpatient facility.