danaguy71@yahoo.com
Networker
Hi All. I have provider who is billing 90837 for individual psychotherapy for Children. The therapists utilizes play therapy which can be appropriate. However, this therapist always says that set up and clean up time is part of the play therapy. The documentation will basically state that whatever type of play therapy the client engaged in, that additional time was required to set up, utilize, and clean up the materials used for play therapy intervention. The utilization I understand. However, the therapist is also saying the set up and clean up time is being counted towards the hour time requirement for 90837. The therapist always documents a start and stop time that equals an hour. In my opinion, it is unclear in the documentation if the set up and clean up time was integral to the session to support the total time for the code billed and involve engaging with the client in a therapeutic manner (e.g., discussing therapeutic goals during setup or processing the session during cleanup). I also can't tell if the child was present for set up and clean up time from the documentation. Additionally, it the documentation does not indicate exactly how much time was allotted for set up and clean up. I asked and AI system about this as I can't find any other supporting documentation and it states:
No. For CPT 90837 (psychotherapy, 60 minutes) the time that supports the code is psychotherapy time with the patient (and/or family member, when applicable) — i.e., face-to-face/in-session time, and does not include pre- or post-session tasks like setting up or cleaning up play therapy materials. CMS contractors and specialty coding guidance consistently frame the psychotherapy timed codes as “with patient” time and require documentation of that encounter length.
So does anyone else interpret this that the therapist would have to indicate that the child was present for the set up and clean up and that it was integral to the psychotherapy session? This is for a commercial carrier and they do not have any specific policy that addresses this type of situation. I would appreciate any and all input. Thank you!
No. For CPT 90837 (psychotherapy, 60 minutes) the time that supports the code is psychotherapy time with the patient (and/or family member, when applicable) — i.e., face-to-face/in-session time, and does not include pre- or post-session tasks like setting up or cleaning up play therapy materials. CMS contractors and specialty coding guidance consistently frame the psychotherapy timed codes as “with patient” time and require documentation of that encounter length.
How to treat play-therapy setup/cleanup time
- Setup/cleanup done before or after the patient is present (getting toys out, sanitizing, putting materials away): not countable toward the 53+ minutes needed for 90837. (headway.co)
- Time during the session when the patient is present and you are therapeutically using the materials (e.g., structured play-based interventions, processing, skill-building, clinical observation and therapeutic engagement): countable, because that is part of the psychotherapy service delivered “with patient.” (medicare.fcso.com)
So does anyone else interpret this that the therapist would have to indicate that the child was present for the set up and clean up and that it was integral to the psychotherapy session? This is for a commercial carrier and they do not have any specific policy that addresses this type of situation. I would appreciate any and all input. Thank you!
