Question about, who can, and when to use 90785

[tiffanyannd]

In the practice I work for I handle the mental health claims. One of the mental health providers seems to be using play therapy with some of his patients. I have been trying to understand what constitutes the use of code 90785?

In other words, is it enough just for the providers notes to say that they used play therapy? Then describe in the note how it was used? Also what is "play equipment"? In one note it described toys, and another he played basketball with the patient. Are both of those considered "play equipment"?

I would think they are, but I just want to be sure I am interpreting the code correctly. Also I know it is an add on code and I would use it in conjunction with a normal timed session code.

Also is there any reason we could not use 90785 because of credentialing issues? Or because we are an FQHC (Federally Qualified Health Center)?

Our providers are Licensed Social Workers, Psychiatrist, and a Licensed Addiction Counselor. The one using the play therapy is a Licensed Social Worker.

Thanks for any responses.

 

[imomofbk56]

Remote Medical Coder

I am a mental health coder and the description in CPT 2017 gives a very good description of what is required for 90785. Play therapy is used a lot with children and we don't bill 90785 for that. The only time I code for 90785 is when the patient cannot communicate by speech or hearing and uses someone to interpret or is using equipment (such as a computer) to communicate with the provider. If the person you are coding is having some type of communication issue and that is noted then yes use the code but not just for play therapy. To me that is a way to get them to open up and feel comfortable communicating their feelings. The CPT is a good guide on that question. See below an excerpt from Psychiatry.org. Hope this helps.

Complicating Communication Factor Must BePresent During
the Visit

The following examples are NOT interactive complexity:

 Multiple participants in the visit with
straightforward communication
 Patient attends visit individually with no
sentinel event or language barriers
 Treatment plan explained during the visit and
understood without significant interference by
caretaker emotions or behaviors

 

[tiffanyannd]

Okay, so I could use it if they were using play therapy, because the child doesn't really have very developed language skills. Or if the play therapy was being used because the parent is in some type of disagreement about the treatment with the provider. I see, that makes sense to me.

Thank you for your help.