Pediatric Coding Alert

Question: Is it permissible to use CPT 90804 -90809 (psychotherapy) in conjunction with E/M services codes (99211-99215) providing the pediatrician documents the length of time spent counseling?

Judith L. Duke, Insurance Clerk
Clinic for Children, Youth and Young Adults, Hope, AK

Answer: No, because you can use a counseling code which specifically includes an E/M service (90805, 90807, 90809) or not to include them (90804, 90806, 90808). CPT states that in reporting psychotherapy, if the E/M services are furnished on the same date of service, you should use 90804, 90806, or 90808.

To report medical evaluation and management services furnished on a day when psychotherapy is not provided, select the appropriate code from the Evaluation and Management Services Guidelines, CPT states. If you use 90805, for example, you would also code whatever E/M service you provided, along with a modifier -25 appended to the E/M service. The psychotherapy codes are for individual psychotherapy, insight oriented, behavior modifying, and/or supportive, in an office or outpatient facility. Code 90804 is for about 20 to 30 minutes, 90805 is for 20 to 30 minutes with an E/M service, 90806 is for 45 to 50 minutes, 90807 is for 45 to 50 minutes with an E/M service, 90808 is for 75 to 80 minutes, and 90809 is for 75 to 80 minutes with an E/M service.

Note: Interactive psychotherapy, codes 90810-90815, is used with children who do not yet speak.