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Super Posted Wed 10th of November, 2010 19:22:11 PM

We are currently starting a new program that will be providing psychotherapy services (groups in particular {90853), and we are puzzling how to bill more than one group for the same patients on the same day. We are being told there is a way to do this (using modifiers such as "1" and "59"), but we cannot find anything regarding how this is done to Medicare's satisfaction. The reference I found with your service just seemed to write about what constituted group therapy services.

SuperCoder Answered Wed 10th of November, 2010 20:35:34 PM

Group therapy (90853, 90857) sessions should not exceed 10 participants and should be at least 45 to 60 minutes in duration. While a video or movie may be used as an adjunct to the sessions, this modality should not be used as a replacement for the therapist’s active participation and the majority of the session should involve the interaction between the participants and the therapist leading the session. If group psychotherapy is provided to a patient with dementia, the patient’s record should document that the patient’s cognitive level of functioning was sufficient to permit the patient to participate meaningfully in the treatment.

Super Posted Thu 18th of November, 2010 19:43:53 PM

I am still puzzled about how to bill more than one 90853 group session in the same day. Will Medicare pay for two or three submissions of the same coded services on the same day, for the same patient?

SuperCoder Answered Sat 20th of November, 2010 20:27:40 PM

These can be billed in units with total time into calculation avoid billing it multiple times with modifier 59. A total of 5 units can be billed with 90853 if billed as one single line item.

However, billing the cpt 90853 without any modifier in the first line, and with modifier U7 in the subsequent line item would be more appropriate.

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