Primary Care Coding Alert

Question: What is the difference between psychiatry codes 90801-90802 and 90804-90829?

South Dakota Subscriber

Answer: The first series of codes are diagnostic codes. For example, 90801 describes a "psychiatric diagnostic interview examination." A family physician generally provides this service during the initial phase of treatment to establish a diagnosis and a treatment protocol. The service includes a history, mental status assessment, and treatment plan formulation and may also include ordering and interpreting diagnostic tests.
 
If the FP furnishes a similar service to children, use psychiatric diagnostic code 90802 (Interactive psychiatric diagnostic interview examination using play equipment, physical devices, language interpreter, or other mechanisms of communication).
 
Codes 90804-90829 describe individual psycho-therapy. You should choose the appropriate code based on where the psychotherapy session occurs, the type of psychotherapy, the amount of face-to-face time the FP spends with the patient, and whether the physician provides medical E/M services on the same date as the psychotherapy service.
 
Example: An FP provides insight-oriented psychotherapy for 20 to 30 minutes in his office without any medical evaluation and management of the patient. You would code the visit with 90804 (Individual psychotherapy, insight-oriented, behavior-modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient). But if he also provides medical evaluation and management in addition to insight-oriented psychotherapy you would use 90805 (... with medical evaluation and management services).