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cpt codingMajor changes in psychiatric procedure coding will take effect in 2013. As you peruse the AMA CPT manual between page’s 483 through 487, you will see columns of green print with symbols ►◄ indicating new or revised text. You will also see a red circle • indicating new codes.

2013 Psychiatric CPT Coding Changes

The first new code listed under Psychiatry is an add-on code + 90785 which is Interactive Complexity. It is reported in conjunction with diagnostic evaluation codes as well as psychotherapy codes and psychotherapy when performed with an E/M service codes. This code refers to specific communication factors that complicate psychiatric services due to situations involving an emotional family, language barriers, court officers, etc. When billed with a psychotherapy or psychotherapy code with an E/M, time should be reflected in the psychotherapy code specifically- not the 90785 – Interactive Complexity.

Diagnostic evaluation codes 90801 and 90802 have been deleted and replaced with 90791 and 90792. These new evaluations may include communication with family or other sources as well as review and ordering of diagnostic studies. 90791 and 90792 may be reported more than once for the patient when separate evaluations are conducted but be sure to double check with payers before you attempt to follow these guidelines.

Individual psychotherapy codes have changed from 90804/30 minutes psychotherapy, 90806/45-50 minutes psychotherapy, and 90808/75 to 80 minutes psychotherapy to 90832/30 minutes, 90834/45 minutes, and 90837/60 minutes. The new add-on codes +90833/30 minutes psychotherapy, +90836/45 minutes psychotherapy, and +90838/60 minutes psychotherapy indicate an additional evaluation and management service was provided with the psychotherapy service. Bill the E/M first and follow the guidelines of an E/M medical service based upon key components of history, exam, and medical decision making. The time of the visit is in the psychotherapy code.

New codes 90839 and add-on code 90840 are used to report the total duration of time face-to-face with the patient or family member spent by the physician or other qualified healthcare provider providing crisis psychotherapy, even if the time is not continuous. The patient must be present for some or all of the service.

Family psychotherapy without the patient- 90846 and family therapy with the patient-90847 have not changed as well as other procedures such as group therapy in the Psychiatry Section.

The last new change +90863 replaces 90862. This is an add-on code for Pharmacological Management when performed with the new psychotherapy services 90834, 90837, and 90838.

For coders who work with Mental Health, crosswalk your CPT® codes and understand the new guidelines for 2013. It is important to review this segment in the coding manual and bubble and highlight the important information indicated in green print and in the parenthesis as taught in the coding program:

CPT® Coding Related Content:

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2017-11-10T19:56:59+00:00

About the Author:

JoAnne Sheehan
JoAnne Sheehan has been successfully providing medical billing, coding and practice management services in the New England area for over thirty-three years. She has witnessed the evolution of healthcare and the increased complexities of medical billing and coding regulations, creating a need for education in this field. JoAnne has been featured in numerous medical publications and has acted as a medical billing expert in highly profiled Medicare and Medicaid fraud cases in Boston and has trained others on both a local and national level in medical billing and coding. She is a certified medical coding instructor, practice management consultant, and an AAPC approved ICD-10-CM instructor. Her hands-on experience is an asset for the CCO students she coaches. She is President and Founder of Lomar Associates, Inc., a practice management company established in 1981.

3 Comments

  1. T Thivierge December 16, 2013 at 8:08 pm - Reply

    What CPT code would you use for walk and talk therapy? I hear it is the up and coming trend of therapist of patient who want to say “kill two birds with one stone”…walk for exercise which can be calming and do therapy with their licensed clinician. I know the therapist would have to have the patient sign a special consent to this type of practice on certain occasions. Would this type of therapy be using add on code of 90785? How would therapist document in his or her notes?

    Thank you in advance

    • Laureen
      Laureen December 19, 2013 at 12:23 pm - Reply

      Hi Thivierge – I’d post this question on our discussion forum to get a response. It is something that would require a bit of research. http://www.cco.us/forum

    • JoAnne Sheehan, CPC, CPC-I, CPPM December 27, 2013 at 9:57 am - Reply

      If you read what code 90785 stands for, it refers to specific communication factors with a patient that complicates psychotherapy. The criteria is very specific. If that is what you are referring to, then I would consider 90785 as an add-on code.

      Code 90785 is an add-on code for interactive complexity and can be used with a psychotherapy session. Walking with a patient would certainly help an anxious, highly reactive, or disagreeable patient in many situations and would fall under the category “psychiatric procedures” with interactive complexity.

      There are a number of factors available that allow the use of CPT code 90785. I believe the example below may best suit what you are talking about:
      One of the following situations must be present: use of play equipment, “OTHER PHYSICAL DEVICES”, interpreter, or translator to communicate with the patient to “overcome barriers” to therapeutic or diagnostic interaction between patient and therapist.

      Documentation will indicate the time spent in psychotherapy and your means of treating the patient through physical devices – in this case, it could be walking, cycling, gardening or even swimming. It is a fairly new concept so you would have to focus on how fast the patient walked, how long, was walking indoors or outdoors, etc. Research is still being done but if the reason for using 90785 with psychotherapy meets all the criteria, then my physical device would be the ground and area you walked and talked with the patient. (MY OPINION)
      I would recommend getting authorization from the insurance carrier if you were concerned about lack of payment. Also, they can clarify for you “exactly” what they consider a physical device. It could be a walking stick.
      Also, if you are just providing psychotherapy with no interactive complexity, I would bill for the time invested in the psychotherapy. Your notes can indicate you provided a therapy session while walking and the time and results would be documented as well. Therapists treat patients over the phone and bill for psychotherapy when a patient cannot make it to the office.
      This is my opinion on the issue. It really is a very new and exciting way to treat patients. I bet the end results would be very positive.

      As a mental health provider, I do not believe you are qualified to bill for any physiotherapy codes.
      I would be interested to hear what others say.

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