Psychiatry Coding & Reimbursement Alert

Published on Mon Oct 03, 2016 PDF

Question: I am new to psychiatry coding. We were reporting +90785 in addition to psychotherapy services and E/M codes for a patient with communication difficulties. In the last session with the patient, our clinician did not conduct a psychotherapy session with the patient but only performed an evaluation as the patient had some changes in her symptoms. Should I report +90785 with the E/M code that we are reporting as is the practice with psychotherapy codes?

Louisiana Subscriber

Answer: The add-on code +90785 (Interactive complexity [List separately in addition to the code for primary procedure]) has been created with the intention of providing additional reimbursement to help compensate for the extra time that your clinician had to spend due to communication difficulties. However, your use of the interactive complexity code should be restricted to psychiatry codes.

In the previous visits, since your clinician was performing psychotherapy (with or without E/M services), you were right in appending +90785 to the psychotherapy code. In this visit, since no psychotherapy service was provided, you cannot report the add-on code for interactive complexity if you are only reporting an E/M code for the visit. One of the parenthetical instructions following +90785 in the CPT^® manual specifically states, “Do not report 90785 in conjunction with . . . E/M services when no psychotherapy service is also reported.”

You have not mentioned the time that your clinician spent in performing the E/M service. If your clinician had to spend substantially more time in performing the E/M service than is typical for that service, then you may be able to append a add-on prolonged services code such as +99354 (Prolonged evaluation and management or psychotherapy service[s][beyond the typical service time of the primary procedure]in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour [List separately in addition to code for office or other outpatient Evaluation and Management or psychotherapy service]) to the E/M code.

Note: You cannot report a prolonged services code if the prolonged portion of the E/M service is less than 30 minutes in duration. If the duration of the prolonged portion of E/M service was below 30 minutes, only the E/M code should be reported.