Payer preference drives decision to use modifiers.
If you’ve ever gotten a puzzling denial for a psychotherapy session provided by a clinical psychologist (CP) or clinical social worker (CSW), you’re not alone. There is many a coder who has been flummoxed by payer peculiarities for these services.
The problem could have been as simple as a missing modifier. Check out this quick FAQ on coding for psychotherapy sessions.
It depends on the payer. Some payers don’t require modifiers on psychotherapy codes, but some prefer that you append a HCPCS (Healthcare Common Procedure Coding System) modifier to the code. These HCPCS modifiers let the payer know that the provider who performed the service was a qualified CP or CSW.
Two of the most common modifiers you’ll use on psychotherapy claims are AH (Clinical psychologist) or AJ (Clinical social worker).
Example: Encounter notes indicate a CSW provides 45 minutes of psychotherapy to a patient. On the claim, you should report 90384 (Psychotherapy, 45 minutes with patient and/or family member) with modifier AJ appended – if the payer requires the modifier.
You should list the appropriate modifier in field 24d of the CMS 1500 form. Make sure you place the modifier after the CPT® code that you use to describe the services performed; in other words, report 90384-AJ.
Do this: If you have any doubts about a particular payer’s policies and rules regarding claims for services provided by your CP or CSW, be sure to contact the payer and ask about modifiers AH and AJ. That way, you do not run the risk of denial for these claims.