• 25 MAY 15

    2013 Psychiatric Procedure Codes

    Medical Providers Part 1

    Psychiatrists and Prescribing Nurse Practitioners

    On January 1, 2013 big changes start for the psychiatric profession. Last month the American Medical Association (AMA) released the 2013 Current Procedural Terminology (CPT) updates. The psychiatric codes we have memorized and used for years will be deleted, changed, or replaced by new ones. Currently the behavioral health medical providers (psychiatrists and the prescribing nurse practitioners) only have a handful of codes they typically use and rarely do they need to choose more than one procedure code to report the service they performed. On January 1st they will move to the more complex Evaluation and Management codes along with an add on code; non-medical providers will need to learn new codes but the requirements for documentation and complexity will not change for them. These changes can seem scary and overwhelming but with education we can learn to use the codes without worry.

    2013 Steps for Psychiatric Procedure Code Selection: Patient Visit

    1. Decide if the patient is a new patient or an established patient
    2. Choose the Evaluation and Management (E/M) service first
    3. Determine if psychotherapy services were provided
    4. Choose the correct add-on code for the psychotherapy service based upon the documented time by the qualified professional
    5. Determine if the psychotherapy service involved interactive complexity
    6. Add the interactive complexity code to the psychotherapy service
    7. Possible total of three procedure codes could be used to represent one patient visit


    New Patient Visit

    Office or Other Outpatient Visit

    Psychotherapy Service Add On Codes

    • Medical Evaluation and Management (E/M)
    • Patient has not been seen by the physician or other member of the physician’s group within the last three years
    • Psychotherapy services are included in the definition of E/M
    • All three components must be met
    • Face to Face time spent with patient and/or family
    • Report when patient receives E/M service on the same day as psychotherapy by same physician or other qualified professional of the same group
    • Patient must be present for all or some of the service
    • Do not report psychotherapy services for sessions less than 16 minutes

    Definition

    Procedure Code

    Definition

    Procedure Code

    • Problem focused history
    • Problem focused exam
    • Straightforward medical decision making

    99201

    • Psychotherapy, 30 minutes
    • (16-37 minutes)
    • Select the evaluation and management code first

    90833

    • Expanded problem focused history
    • Expanded problem focused exam
    • Straightforward medical decision making

    99202

    • Psychotherapy, 45 minutes
    • (38-52 minutes)
    • Select the evaluation and management code first

    90836

    • Detailed history
    • Detailed exam
    • Medical decision making of low complexity

    99203

    • Psychotherapy, 60 minutes
    • (53 or more minutes)
    • Select the evaluation and management code first

    90838

    • Comprehensive history
    • Comprehensive exam
    • Medical decision making of moderate complexity

    99204

    • Interactive complexity (select only when present)
    • List separately in addition to the primary procedure code
    • Report when at least one of the following is present:
    • Maladaptive communication
    • Caregiver emotions interferes
    • Evidence or disclosure of a sentinel event
    • Use of play or physical devices
    • Not fluent in the same language as provider
    • Has not developed or lost expressive language

    90875

    • Comprehensive history
    • Comprehensive exam
    • Medical decision making of high complexity

    99205


    Established Patient Visit

    Office or Other Outpatient Visit
    Psychotherapy Service Add On Codes

    • Medical Evaluation and Management (E/M)
    • Patient has been seen by the physician or other member of the physician’s group within the last three years
    • Patient visit may be for follow up of a previous diagnosis or a new diagnosis
    • Two of the three components must be met
    • Face to Face time spent with patient and/or family
    • Report when patient receives E/M service on the same day as psychotherapy by same physician or other qualified professional of the same group
    • Patient must be present for all or some of the service
    • Do not report psychotherapy services for sessions less than 16 minutes

    Definition

    Procedure Code

    Definition

    Procedure Code

    • E/M service may not require physician or NP
    • Presenting problem is minimal
    • 5 minutes or less spent supervising the service

    99211

    • Psychotherapy, 30 minutes
    • (16-37 minutes)
    • Select the evaluation and management code first

    90833

    • Problem focus history
    • Problem focused exam
    • Straightforward medical decision making

    99212

    • Psychotherapy, 45 minutes
    • (38-52 minutes)
    • Select the evaluation and management code first

    90836

    • Expanded problem focused history
    • Expanded problem focused exam
    • Straightforward medical decision making

    99213

    • Psychotherapy, 60 minutes
    • (53 or more minutes)
    • Select the evaluation and management code first

    90838

    • Comprehensive history
    • Comprehensive exam
    • Medical decision making of moderate complexity

    99214

    • Interactive complexity (select only when present)
    • List separately in addition to the primary procedure code
    • Report when at least one of the following is present:
    • Maladaptive communication
    • Caregiver emotions interferes
    • Evidence or disclosure of a sentinel event
    • Use of play or physical devices
    • Not fluent in the same language as provider
    • Has not developed or lost expressive language

    90875

    • Comprehensive history
    • Comprehensive exam
    • Medical decision making of high complexity

    99215

    CPT © 2012 American Medical Association. All rights reserved.

    CPT © is a registered trademark of the American Medical Association.

    Recommended Publications and Websites:

    American Medical Association. 2013 CPT Current Procedural Terminology Professional Edition: American Medical Association

    “The Medicare Learning Network, Official CMS Information for Medicare Fee-For-Services Providers – Evaluation and Management Services Guide

    Novitas Solutions (Medicare Contracted MAC for areas J12 and JH) Evaluation and Management Center

Radmax Advantages

A total AR management package

We’re the specialists for specialties. We have the expertise in credentialing, coding, billing and AR management to make sure you get the maximum reimbursement for your services. No one offers more client-focused, complete services than RADMAX….
Read More

Blog