Psychiatry Coding & Reimbursement Alert
Use CPT® Time Rule When Using New Codes for Psychotherapy
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Question: I read that we will have to begin using new codes for psychotherapy starting from Jan.1, 2013. I also read that these new codes are also time based like the old code sets. Can you tell me how to report these codes on the basis of time spent on psychotherapy by our psychiatrist?
Answer: You are correct that you will have to begin using new code sets for psychotherapy services that have been performed on or after Jan.1, 2013. You will have to use the following codes if only psychotherapy services have been provided:
90832 (Psychotherapy, 30 minutes with patient and/or family member)
90834 (Psychotherapy, 45 minutes with patient and/or family member)
90837 (Psychotherapy, 60 minutes with patient and/or family member)
If your psychiatrist provided both evaluation and management services and psychotherapy in the same session, you will have to report the appropriate E/M code (based on the components and setting) along with the following add-on codes for psychotherapy:
+90833 (Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service [List separately in addition to the code for primary procedure])
+90836 (Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service [List separately in addition to the code for primary procedure])
+90838 (Psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service [List separately in addition to the code for primary procedure])
Since the new set of codes follow exact times and not time ranges like the older codes, you will have to use the CPT® time rules to report the right codes.
Example: Suppose your psychiatrist performs psychotherapy for 30 minutes, you will have to report the session with 90832. You can use this code once the session crosses the half way mark i.e. 16 minutes; do not report psychotherapy of less than 16 minutes duration. You can use the same code for a session that lasts anywhere between 16 minutes to 37 minutes. When the actual time falls between the times specified in CPT®, choose the code closest to the actual time. Thus, 37 minutes is closer to the 30 minutes specified in 90832 than it is to the 45 minutes specified in 90834. Once the actual time reaches 38 minutes, you are closer to 90834 than 90832.
The same rules apply for the other codes. So, you can use 90834 for a session that lasts anywhere between 38 to 52 minutes and for a session that lasts longer than 53 minutes, you can code 90837.
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