Psychiatry Coding & Reimbursement Alert

Published on Tue Sep 04, 2012 PDF

Question: Our clinical psychologist wants to perform group therapy sessions for patients in our facility. My question is if he is conducting the sessions for a group, should I code 90853 for each patient that is present in the group or should I code the entire session with just one unit of 90853. Also, can you please tell me other guidelines that I need to follow for reporting this code?

Florida Subscriber

Answer: When your clinical psychologist performs group psychotherapy to his patients, you will have to report the session with 90853 (Group psychotherapy [other than of a multiple-family group]). You will have to report this service once for each and every patient that is participating in the group psychotherapy sessions.

For example, if there are eight patients for whom your clinical psychologist is performing a group psychotherapy session, you will have to code 90853 for each of these eight patients. A claim will have to be filed individually for every patient in the group, and if necessary, you may have to submit paperwork with details of the medical necessity of the service being performed. Documentation should include details of the patient's ability to participate in the therapy session, including details of how the therapy will be beneficial to the patient. You should also include an approximate timeframe for these sessions and the number of sessions that your clinical psychologist plans to perform.

The number of participating patients in each session is typically about 8-10 and12 patients is the maximum limit for an effective session. You should remember that if you are making claims with 90853 at numerous intervals, you might be inviting a review from Medicare to see if the services performed by your clinical psychologist are medically reasonable or not.

Also, it is important to note that any music therapy, art therapy, motion therapy, excursions, socialization, sensory stimulation, and cognitive stimulation are not part of medically reasonable and necessary guidelines laid down for group psychotherapy. These services, if performed by your clinical psychologist, should not be reported with 90853.