Psychiatry Coding & Reimbursement Alert

Published on Tue Sep 04, 2012 PDF

Question: Our clinical psychologist has recently started performing group therapy for adolescent patients suffering from attention deficit hyperactivity disorder (ADHD). He is also performing separate sessions for parents of these adolescents. How do I code for these therapy sessions? Can I report the sessions conducted for the parents separately from the sessions conducted for the adolescents? If so, what is the diagnosis I use to support the sessions conducted for the parents as I know I cannot use the same diagnosis that I use for the therapy sessions for the adolescents?

New Jersey Subscriber

Answer: Since the adolescents are undergoing group therapy conducted by your clinical psychologist as an element of active therapy that is directly connected to the condition they are suffering, you can use group therapy codes to report this service. So you can report 90853 (Group psychotherapy [other than of a multiple-family group]) for the therapy provided to the adolescents.

However, as the parents of these adolescents are not part of the active treatment group, you cannot report 90853 for the group sessions that your clinical psychologist holds for them. Instead, you can use 90849 (Multiple-family group psychotherapy) to report the group sessions that your clinical psychologist holds for the parents of these adolescents. You will report this code once for each family group present, not for each family member. Thus, if the group includes six people representing three families, you will report 90849 only three times (i.e., once for each participating family).

But under the Correct Coding Initiative, 90849 is a column 2 code for 90853 with the modifier indicator being '1,' which means that you cannot report the two services separately unless a suitable modifier is used to distinguish the two services performed. Thus, you will have to use the modifier 59 (Distinct procedural service) to report 90849 on the same claim and date of service as 90853, so you can receive reimbursement for both the services performed by your clinical psychologist.

You are correct in assessing that you cannot use the same diagnosis code for the sessions conducted for the parents of the adolescents. Since you cannot use the same primary diagnosis, i.e., ADHD (314.01, Attention deficit disorder; with hyperactivity), you will need to use another code that identifies the reason for the family therapy. Options include:

• V61.23-V61.25 (Counseling for parent-child problem)
• V61.49 (Health problems within family; Other), which includes care of a sick or handicapped person in family or household
• V65.19 (Other person consulting on behalf of another person), which includes advice or treatment for non-attending third party)
• V65.40 (Other specified counseling)
• V65.49 (Other specified counseling)