Psychiatry Coding & Reimbursement Alert

Published on Mon Feb 11, 2013 PDF

Question: One of our new clinical psychologists performs hypnotherapy sessions for his patients. I am new to psychiatry coding and I am not sure about how to code this. I was checking with some of the carriers and saw that this is not a covered service with many of them. So, I brought this to our clinical psychologist, and he was of the opinion that we can code it as an established patient E/M service based on time. I think that is wrong, but I am not too sure about this.

West Virginia Subscriber

Answer: You are right that you cannot report hypnotherapy sessions using new patient E/M codes 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient…) or established patient E/M codes 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient…) or any other psychotherapy codes based on time spent with the patient for the session. You cannot do this because there is a specific CPT® code for hypnotherapy that you will report when your clinical psychologist performs a session. You will report a hypnotherapy session using 90880 (Hypnotherapy).

Even though some payers might not provide coverage for hypnotherapy services, there is no other CPT® code that you can report as a substitute to 90880 to report a hypnotherapy session. Reporting a different CPT® code may still lead to denial of reimbursement, and it may also get you in trouble for making false claims.

Alternative: Instead, try to support your claims for 90880 by providing adequate documentation suggesting the medical necessity for conducting the hypnotherapy session to the particular patient. There are a few indications wherein hypnotherapy is a covered service. Some such indications where payers reimburse you for hypnotherapy services include anxiety reduction, management of chronic pain, enhanced psychotherapy, and as an adjunct therapy for somatoform or adjustment disorders.

So, when your clinical psychologist performs a hypnotherapy session for a patient, note whether the indications are covered under the payer’s policy, and if so, submit documentation supporting your claim.

You can also keep the patient informed that the insurance carrier may not cover the particular service and that the patient will have to pay from his/ her pocket if the reimbursement for the service is denied.