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90837 - Letter from BCBS Regarding Usage

ejallo 2 months ago in Industry News/Discussion updated by William Paige-Evans 2 months ago 11

We have had a couple providers receive a letter from BCBS about their "higher than the expected billing distribution" for code 90837.  It''s asks that the provider contact their "Provider Education Team" so they can "further understand your coding methodologies and billing practices."

Has anyone else received one of these?  

Thanks!

I don't recall that we have seen anything here at our agency in regards to this code and we do bill 90837 quite a bit throughout our organization.    Had you guys been using the 90837 quite a bit in the past, or is it something more newer to your organization?  Can I ask what BCBS the letter was from as well?

Thanks

Amber

It was from BCBS MN.  We haven't changed the way we bill and have always used the 90837.  They just monitor the usage because they want providers using the 90834. 

Of course they want providers to use the 90834, because it's cheaper for them!  We bill for both BCBS ND & MN and haven't seen anything yet, so fingers crossed.  We've been using the 90837 code for several years now too.

+1

Yes, I got the same letter August 9, 2019.  BCBS has not contacted me since.  The history of 90837 goes back to the conclave in 2014 when CMS and the "select" members of the medical community, the conclave, re-evaluated the RVU for mental health services.  Realizing that most mental health professionals spent over 52 minutes with clients, they decided to create 90837 for 2015.  While this is appropriate, and while most  of us use the code appropriately, expect BCBS to attempt to "influence" us to use the 90834 so they may save money.  As long as we're following our professional ethics and justifying the use of the code in meeting our clients'  needs, I suggest not giving in to any anxiety to either bill 90834s or spend less  time with clients to make BCBS happier.  After all, the insurance industry spends well over 90% on physician services compared to either mental health services or chemical health services.

Take care and be safe,

Bill

We get letters all the time.  I completely agree with William.  We also checked with the American Psychology Association and they stated that they can not tell you what to bill and as long as time spent and documentation supporting that to disregard the letters.

Hi Bill, 

Did you respond to their letter at all? 

Thanks

Good morning,

No, I offered no response.  They didn't direct or request a response.  So, I continued, and continue, to devote my time to providing services to meet clients' needs.  I hope this helps.

Best regards,

Bill

Yes, we got the same letter. I emailed them with our reasoning for billing this code.

Yes, we got one for one of our providers.  We use 90837 quite a bit, most often really.

We used to go through this a lot, particularly with Medica who was denying 90837's.  Then they got with it and have been good lately.

If you billed 90837 over something like 64% of the time during the reporting period then you got the letter.

We had a conversation with BCBS about this this morning and that was the information provided