2013 Psychotherapy Codes Better Describe Care: Part 2
By Cindy Harms, M.Ed., CPC-I, CPC-H
Sweeping changes to psychotherapy CPT® codes mean a fresh way to report changing modes of care, but they also mean new requirements must be must be documented and reported for the first time in many years.
Per CPT®, psychotherapy time is face-to-face services with the patient and/or family member, with the patient present for some or all of the service.
• A session between 16-37 minutes is reported 90832 Psychotherapy, 30 minutes, with patient and/or family member. A session less than 16 minutes should not be reported.
• A session between 38-52 minutes is reported 90834 Psychotherapy, 45 minutes, with patient and/or family member.
• A session of 53+ minutes is reported 90837 Psychotherapy, 60 minutes, with patient and/or family member.
Diagnostic Interview (90791)
The session begins with face-to-face contact. When the psychologist meets the patient in the waiting room, the clock starts. This code does not include the time spent calling referrals or documenting the encounter. These activities are, however, considered in the work valuation of the code.
Codes for Psychotherapy Crisis Situations
Psychotherapy sessions lasting longer than 75 minutes tend to be crisis situations, reported with 90839 Psychotherapy for crisis, first 60 minutes and +90840 …each additional 30 minutes. These codes should be used for intense, intermittent engagements, such as life-threatening situations that require immediate attention.
Interactive Complexity Add-on Code
Interactive complexity +90785 could be used for a greater degree of cognitive interaction, such as may be needed when working with children or patients with dementia or psychosis. This add-on code should be used with codes for primary service: psychiatric diagnostic evaluation, with no medical services 90791; psychotherapy 90832, 90834, and 90837; psychotherapy when performed with an evaluation and management service (90833, 90836, 90838, 99201-99255, 93304-99337, 99341-99350); and group psychotherapy 90853.
Interactive complexity includes factors during a visit that complicate the delivery of a service to a patient, such as the use of physical aids and play therapy used to overcome barriers to communication. This code could also be used when arguing or emotional family members in a session interfere with providing the service; third-party involvement with the patient, including parents, child welfare agencies, guardians, probation officers and schools; and the need for mandatory reporting of a sentinel event, such as abuse or neglect, serious physical or psychological injury. Per the Center for Medicare and Medicaid Services (CMS), “90785 generally should not be billed solely for the purpose of translation or interpretation services,” as that may be a violation of federal statute.
Pharmacology Management by Psychologists
New add-on code +90863 Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services should be used by psychologists who prescribe medications for their patients. This code is used only as add-on to primary psychotherapy codes 90832, 90824, or 90837. Do not report +90863 as an add-on to E/M codes.