Wiki Intent of CPT 90837

bbradish

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What is the Intent of CPT 90837

This year's revision of psychotherapy codes has created confusion. I have a therapist who has a treatment plan for family therapy for my member. The member's benefit does not cover group therapy. Provider originally billed and was paid under CPT 90847 Family Therapy. System configuration was corrected to deny 90847 so the provider changed to billing and being paid for CPT 90837 'Psychotherapy with patient AND/OR family member'. I believe the new code is meant for occasional family participation in an individual's treatment and NOT family therapy. Is the provider commiting fraud by billing this way?
 
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Use of Codes

As an Investigator I research Fraud, Waste and Abuse. I am looking for feedback on the intended use of these codes.
 
This year's revision of psychotherapy codes has created confusion. I have a therapist who has a treatment plan for family therapy for my member. The member's benefit does not cover group therapy. Provider originally billed and was paid under CPT 90847 Family Therapy. System configuration was corrected to deny 90847 so the provider changed to billing and being paid for CPT 90837 'Psychotherapy with patient AND/OR family member'. I believe the new code is meant for occasional family participation in an individual's treatment and NOT family therapy. Is the provider commiting fraud by billing this way?

IMO: Family therapy and Group therapy are 2 different things. Group therapy is for a group of individuals with related problems being treated as a group by the provider.

You said the provider was paid for 90847; why did the "system configuration" change the code?

I came across this from The American Psychological Association, maybe this will help:
Frequently asked questions about the 2013 psychotherapy codes
What distinguishes the psychotherapy with patient and/or family member present codes (90832, 90834 or 90837) from family psychotherapy codes (90846 and 90847)?

With the 30-, 45- and 60-minute psychotherapy codes, the focus of the service delivered is on the individual patient (even though the CPT code titles for 2013 no longer include the word “individual” before “psychotherapy”). The codes can be used with the occasional involvement of family members.

With the family psychotherapy codes, the focus of the service delivery is on family dynamics or interactions – or a subset of the family such as parents or children – though the treatment is still intended for the benefit of the patient.

www.apapracticecentral.org/codes

Another informational website: http://psychcentral.com/

I'm laid up today with my knee in a brace due to medial collateral ligament sprain. Thanks for giving me something to work on!! :D

Hope this info helps!
 
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