If you are someone who offers in-depth sessions that last up to 60 minutes, you might be using the 90837 CPT code. Billing your therapy sessions using the 90837 CPT code can at times feel like an uphill battle with no ends in sight.

Don’t worry, you aren’t alone. It’s no secret that in order to get paid for all your sessions, you need to ensure precise documentation and proper use of the code. By incorporating the best practices and avoiding errors, you can make this entire process simpler and your billing stress-free. To top it off, these practices will also help you avoid claim denials and audits.

Read on to learn more about the dos and don’ts for this particular billing code and find out how it can help you maintain credibility while also eliminating the billing complexities you face.

An Overview of CPT Code 90837

As a mental health provider, you can use CPT code 90837 when you offer a 60-minute long psychotherapy session. The sessions that you bill with this code involve face-to-face therapy that addresses complex mental health issues.

For instance, if you are planning to explore the client’s emotional challenges, you might need to plan or strategize accordingly. Some of these techniques require more time, which increases the session length. The CPT code 90837 will help you bill your patients accurately and ethically for these long and in-depth sessions.

To use this code effectively, you have to maintain clear and precise documentation. The document should justify the time you spent on the therapy and offer notes on the care you provided. Details on the interventions should also be given to reduce the chances of audits or mistakes.

This code prioritizes extensions in the session and justifies the time spent. It also focuses on the complexity involved, so that you get paid for the time spent on the session.

The Dos for Billing Therapy Code 90837

If you are planning to use billing therapy code 90837 for your sessions, you must ensure it is done properly. Here are all the things you must do to eliminate risks and errors.

Ensure Proper Documentation 

When you are using the code 90837, your documentation should be detailed and accurate. Mention the start and stop time for the session, so that they can verify if the code works for this billing. Ensure you have included the therapeutic goals for the client and the response of the patient.

These details will help you justify the length of the session and also mention how it was impactful. Ensure complete clarity while mentioning the techniques and client progress. With these details mentioned properly, you can ensure there are no audits and the session is reimbursed. You can also use HIPAA-compliant AI scribing tools or EHR tools to standardize and automate the entire process.

Verify the Insurance Coverage

Validate the patient’s insurance coverage to check if they are covered for CPT code 90837 before you add it to your billing. In some cases, the insurance may require specific additions to cover this code. A lot of patients may not have insurance that covers this particular CPT code.

When you verify the insurance, you can reduce the chances of unexpected denials. At the same time, you can prepare your patients for the additional expense they may incur in this case.

Check the Payer’s Policy

The insurance company you are approaching may have specific rules concerning this code. You must familiarize yourself with these requirements, such as documentation standards, the number of times it can be claimed, and authorization needs.

By knowing these, you can eliminate the risk of a claim getting rejected and streamline the billing. You can even tailor the billing process to meet the insurer’s guidelines for a smooth process.

Know the Compliances

The billing regulations for the 90837 CPT code may be updated regularly. You must review the code guidelines, the payer’s policy, and other compliance standards to ensure your billing practices are accurate and updated.

This would essentially reduce the audits needed for your billing practice and help maintain your credibility as a healthcare professional.

Use Add-on Codes as Needed

In case of complex situations or a crisis, you can add a few other codes to improve the billing accuracy. For instance, if you needed extra time for assessment, your 90837 may not cover this. You can introduce another code that covers this aspect so that you maintain the billing accuracy and justify the care provided.

The Don’ts for Billing Therapy Code 90837

Here are a few things you should avoid when using the code 90837 for mental health billing.

Avoid Overusing the Code

If you seriously believe that the session length of 50 minutes or more is justified, use the code. In case you overuse the code while not being able to justify it, you may raise red flags. The insurance provider might request an immediate audit or reject the claim altogether.

Moreover, you may face damage to your credibility if you misuse or overuse the code. Make sure to check if the code is applicable before proceeding with it.

Don’t Ignore Claim Denials

Claim denials are normal but, you cannot avoid them. It can cost you heavily if you don’t follow up or note the reason for the denial. It could be anything from a missing document or a payer-specific requirement.

By addressing them, there is a good chance you can get paid for the session you were denied, and ensure you don’t repeat these mistakes. Recognizing the reason can also help you maintain the cash flow and reduce the admin stress.

Dodge Coding Mistakes

If you make mistakes while coding in the billing, you may get impacted. It can lead to rejections or delays in payments. You should always double-check the details, including the code you have added. Make sure to include the session duration and accuracy of the documentation.

You should always look for the information on the client’s record and match it with the insurance details. By taking time to review the billing, you can reduce errors and ensure successful payments.

Don’t Assume Uniformity

Different insurance providers look at the same code differently. For instance, a particular insurance provider may approve the claim with the given documentation, while someone else may need prior authorization. In some cases, the provider may also ask for additional documentation.

You should research the insurer and their billing requirements before proceeding with the claim. This way you can tailor the approach to the payer’s requirements, and minimize the chances of claim denial.

Conclusion

Billing using CPT code 90837 accurately can ensure a sustainable and successful practice. By implementing a few things and avoiding some of the practices, you can ensure accuracy.

For instance, detailed documentation and insurance coverage verification can help you fasten the claims. Additionally, if you understand the payer policies and don’t assume their parity, you can enjoy successful approvals.

It is crucial to stay compliant, maintain transparency, and build trust for a smooth reimbursement process. You must start by prioritizing accuracy and relevance to enjoy simple and stress-free billing services.