Question 90839 and +90840 Guidelines Question

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In the guidelines for code 90839, it specifies to use this code for "first 30-74 minutes of psychotherapy for crisis on a given date". However, the code description states: 90839--Psychotherapy for crisis, first 60 minutes". The add-on code of +90840---each additional 30 minutes. I gave a quiz, and the question was: List the code for Psychotherapy for crisis, total time 70 minutes? Which is correct; the guidelines, or the code description, or am I missing something? I teach coding, and my students caught this discrepancy when trying to answer a question on a quiz.
 

AnnieP

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To answer the first question, it is 90839. There is the 'less than 15 minute' cushion in case the visit goes beyond 60 minutes but isn't enough to justify an add-on. On the other end of the code, it the visit it not at least 30 minutes, the hour long code should not be billed.
 

Thelly27

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I want to say that the answer is 90839, because this code encompasses 30-74 minutes. anytime beyond (75 mins or greater) you would append the add on. (it would then be 90839 , +90840)
 

pconrad

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Might I also ask a related question. We have a clinician who billed 240 minutes for a crisis situation. She billed the 90839 for the initial 60 minutes and 6 units for the 90840. Based on the clinical notes, I'm seriously questioning the validity of the coding. However, should the claim be submitted with the 90840 itemized six times or can it be billed with 6 units. (If found to be valid.)
Thank you in advance.
 
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I'm fairly new to Behavorial Health billing. Later months of 2019 we had handful of patients in after suicide attempts. My Medicaid MCO's want more than their regular DX of Major depressive disorder, Panic disorder or Anxiety disorder. Could we add R45.81 Suicidal Ideations? Thoughts please.
Thank you.
 
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Albany, Oregon
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I'm fairly new to Behavorial Health billing. Later months of 2019 we had handful of patients in after suicide attempts. My Medicaid MCO's want more than their regular DX of Major depressive disorder, Panic disorder or Anxiety disorder. Could we add R45.81 Suicidal Ideations? Thoughts please.
Thank you.
If the patients have actually attempted suicide then you would use T14.91- A initial; D Subsequent or S Sequela for the 7th character. If they are only having suicidal ideation then add the R45.81.
 
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If the patients have actually attempted suicide then you would use T14.91- A initial; D Subsequent or S Sequela for the 7th character. If they are only having suicidal ideation then add the R45.81.
Thank you for your response. That's what I was leaning towards, just wanted additional input. Again, Thank you.
 

Arnkpc

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Denver, CO
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To answer Cherylpeters question, both the guidelines and the code description are accurate. The code description for 90839 is psychotherapy for a crisis, first 60 minutes. The guidelines help us understand how to use them since therapy sessions aren't uniform and can run short or last longer depending on circumstances. That's why the guidelines give windows of time to show which code is appropriate.

90839 is used for the first hour, and +90840 is used for each additional 30 minutes. However, the patient needs to be seen for at least 30 minutes for 90839 to be used. And then, beyond that first hour, the patient needs to be seen for a minimum of 15 minutes additional minutes for +90840 to be used.

So the guidelines are saying that 90839 covers 30mins up to 74 minutes
and then the add on code +90840 is for 15mins. up to 44 mins., beyond that first hour.

For me, seeing different time examples always helps me understand they timed/add on codes work together. So here are a couple examples:

Crisis psychotherapy:

10 minutes = Neither code
30 minutes = 90839 (Min. amount of time for this code to be used)
74 minutes = 90839 (Max amount of time for this code to be used)
75 minutes = 90839, +90840 ( min. amount)
104 minutes (1 hr + 30 min. + 14 min.) = 90839, +90840 (max time for these codes)
105 minutes (1 hr + 30 min. + 15 min.) = 90839, +90840, +90840 (min time for these codes)
134 minutes (1 hr + 30 min. + 44 min.) = 90839, +90840, +90840 ( max time for these codes)
135 minutes (1 hr + 30 min. + 30 min. +15 mins) = 90839, +90840, +90840, +90840 (min time for these codes)
164 minutes (1 hr + 30 min. + 30 min. + 44 mins) = 90839, +90840, +90840, +90840 (max time for these codes)

30-74 mins. =90839
75-104 mins =90839, 90840
105-134 mins = 90839, 90840, 90840
135-164 mins = 90839, 90840, 90840, 90840 and so on.
 
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