Medical Review

Psychotherapy Targeted Probe and Educate Review Results

The Jurisdiction F, Part B Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of CPT® 90837 - Psychotherapy. The quarterly edit effectiveness results from October 1, 2019 through December 31, 2019 are as follows:

Top Denial Reasons

  • Failure to Return Records
  • The information provided does not support the level of service as shown on the claim
  • Documentation submitted was not authenticated/signed by the author

Educational Resources

Education

Failure To Return Records

The Internet-Only Manual (IOM) addresses timeframes for submission of records for pre-payment reviews in the Medicare Program Integrity Manual, Publication 100-08, Chapter 3, Section 3.2.3.2.

"When requesting documentation for prepayment review, the MAC and ZPIC shall notify providers that the requested documentation is to be submitted within 45 calendar days of the request. The reviewer should not grant extensions to providers who need more time to comply with the request. Reviewers shall deny claims for which the requested documentation was not received by day 46."

Psychotherapy

CPT® 90837 is to be reported for one hour of face-to-face time spent with the patient. Any service that is performed via phone call should not be reported with this code. The documentation for this service must include one hour of documented time. If the documentation does not support one hour, it will be down coded to the appropriate CPT® code.

Signature Requirements

The Internet-Only Manual (IOM) also outlines Medicare signature requirements in the Medicare Program Integrity Manual, Publication 100-08, Chapter 3, Section 3.3.2.4. The IOM states:

"For medical review purposes, Medicare requires that services provided/ordered be authenticated by the author. The method used shall be a handwritten or electronic."

Examples of acceptable signatures are also located within this manual which may be accessed at:  https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/pim83c03pdf.pdf

 

Last Updated Tue, 25 Feb 2020 15:09:43 +0000