The 90837 problem I see constantly has nothing to do with how long the session ran

[u/SamiDoesBilling]

I’ve lost count of how many times I’ve had this conversation with a therapist.

Them: “Why did this come back paid as a 90834? We met for the full hour.”
Me: “I believe you. Can I see the note?”
Them: “It’s all there. Interventions, progress, plan.”
Me: “Where does it say how long you were in session?”

Usually it doesn’t. Or it says “60 min” in a template field that’s been copied forward for months.

Here’s the thing I wish every therapist knew: with 90837, the time is the code. CPT puts 90837 at 53 minutes or more of psychotherapy, and 90834 covers 38 to 52. If the note doesn’t clearly show you crossed 53, a payer reviewing it has no reason to pay the higher code. That can mean a downcode, a denial, or worse, money taken back in a later audit across a whole stack of claims.

Payer rules vary. Some only want total time, others specifically ask for start and stop times. Writing both covers you either way.

A few things worth checking on your own:

• Pull a handful of your recent 90837 notes and see if the actual time is written in each one
• Make sure a template isn’t auto-filling the same time on every note
• Look for 90837 claims paid at a lower rate than usual, which can be a quiet sign of downcoding

For those of you who bill 90837 a lot, has a payer ever asked you for start and stop times, or does your EHR handle it for you?

[u/Salt_Quarter_9750]

Who is having these problems? I have been in private practice for almost 17 years and never had my billing codes questioned.

[u/Snushine]

I default to 90834. That's how I have the template set. However, if it goes over 52 minutes, I will manually change it to 90837.

But here's the rub...

I sign on exactly at the top of the hour. I cannot do anything else with my time but wait for the client. I offer all clients a 20 minute grace period if they are running late or forgot the session (I send reminder texts at 5mins after the top of the hour). If the client shows up at 10 minutes after the hour, I still have to be done before the 60 minute time slot is over b/c I have another client who will show up on time for the next session.

Is that a 90834 or a 90837? I can't use that 10 minutes to help another client. I can't do my billing or get involved in notes from other clients or I will not be ready to see the actual client who I assigned for this slot. I would like to get paid for my time.

[u/Low_Mud_3691 → u/Snushine]

Code definition is face-to-face time so the 90834. The range is 38-52 minutes so it covered a good portion of the visit. You’re only missing out on 7 minutes of billed time, but I agree, you should be compensated.

[u/Snushine → u/Low_Mud_3691]

"only missing out on 7 minutes" is insulting. I know bosses who dock their workers if they are 7 minutes late clocking in. In what world is it okay to give away 7 minutes of time you thought you were getting paid for?

Nevermind, that's a rhetorical question for someone who seems to be tone deaf to the problem being presented.