• 26 MAY 15

    2013 Psychotherapy Codes for Non-Medical Providers

    Medical Providers Part 2

    This article reflects information from the 2013 Physicians’ Current Procedural Terminology (CPT®) manual. CPT® is a registered trademark of the American Medical Association.

    CPT® five digit codes, nomenclature and other data are copyright 2012 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

    REASONING FOR CHANGES

    1. New codes were created due to the rise in complex outpatient services being provided to patients with difficult and/or co-morbid diagnosis (the current codes did not present a clear picture of the treatment being provided to patients).
    2. The codes prior to 2013 were minimal and did not provide adequate descriptions of psychotherapy work.
    3. The use of the new codes helps accommodate the reduction of hospital, residential or long term care that was once provided to high risk patients.
    4. Until 2013 both medical and non-medical providers reported visits with patients using the same codes.
    5. The codes were loosely organized and vague leaving a lot of room for interpretation of the code or twisting of the code to make it fit the need.

    ORGANIZATION CHANGES

    1. Codes have been created for qualified healthcare providers both medical and non-medical providers.
    2. Medical providers can choose from either set but non-medical providers must choose from the psychotherapy list only.

    DIAGNOSTIC INTERVIEW/EVALUATION WITHOUT MEDICAL SERVICES

    (-) Deleted Code(s)

    90801— Psychiatric diagnostic interview examination

    (+) New Code(s)

    90791 — Psychiatric Diagnostic Evaluation

    Usage and Coding Tips

    • May be billed by all qualified healthcare providers
    • Is used for assessment(s) and reassessment(s) and does not include psychotherapeutic services
    • Evaluation includes: 
      1. Biopsychosocial assessment
      2. History
      3. Mental status
      4. Recommendations
    • Evaluation sources:
      1. Communication with patient
      2. Communication with family
      3. Communication with other sources 
      4. Review and ordering of diagnostic studies
    • Circumstances may allow the following:
      • One or more parties may be seen in lieu of the patient:
        1. Family members
        2. Guardians
        3. Significant Others
      • Possible to report the procedure more than once per patient when separate diagnostic evaluations are performed with the patient or other party.
      • Bill the service for the patient even if the evaluation does not have the patient present.
      • May be reported once per day providing other management services are not performed for the same patient on the same day.
    • When interactive complexity is involved use 90875 in conjunction with 90791.

    INTERACTIVE COMPLEXITY

    (-) Deleted Code(s):

    90802 — Interactive psychiatric diagnostic interview examination
    90810-90815 — Individual outpatient interactive psychotherapy

    90823-90829 — Individual inpatient interactive psychotherapy  

    90857 — Interactive group psychotherapy

    (+) New Code(s):

    +90785 — Interactive Complexity (list separately in addition to the code for primary procedure)

    Usage Tips:

    • Refers to specific communication factors that complicate the delivery of a psychiatric procedure.
    • Common factors are:
      • Difficult communication with a family member who is distraught or antagonistic
      • Dealing with an young patient lacking verbal skills
      • Working with an under developed impaired patient
      • Patients with third parties involved with their care:
        1. Parents, guardians, or other family members
        2. Interpreters and language translators
        3. Agencies, court officers, or schools
    • According to the American Medical Association CPT 2013 Professional Edition, Interactive complexity may be reported when at least one of the following is present:
      1. The need to manage maladaptive communication (related to, e.g., high anxiety, high reactivity, repeated questions, or disagreement) among participants that complicates delivery of care.
      2. Caregiver emotions or behavior that interferes with the caregiver’s understanding and ability to assist in the implementation of the treatment plan.
      3. Evidence or disclosure of a sentinel event and mandated report to third party (e.g. abuse or neglect with report to state agency) with initiation of discussion of the sentinel event and/or report with patient and other visit participants.
      4. Use of play equipment, other physical devices, interpreter, or translator to communicate with the patient to overcome barriers to therapeutic or diagnostic interactions between the physician or other qualified health care professional and a patient who:
      • Is not fluent in the same language as the physician or other qualified health care professional, or
      • Has not developed, or has lost, either the expressive language communication skills to explain his/her symptoms and response to treatment, or the receptive communication skills to understand the physician or other qualified health care professional if he/she were to use typical language for communication.

    Coding Tips:

    • Add-On Code — it cannot be billed alone
    • Can be reported in conjunction with medical and/or non-medical codes. Non-medical codes are:
      • Diagnostic evaluation — 90791
      • Psychotherapy codes
      • Psychotherapy for crisis — 90839 and 90840
      • Psychoanalysis — 90845
      • Family psychotherapy w/o patient present — 90846
      • Family psychotherapy w/ patient present — 90847
      • Multiple-family group psychotherapy — 90849
      • Group psychotherapy other than of a multiple-family group psychotherapy

    (-) Deleted Code(s):

    90804 and 90816 — Individual psychotherapy 20-30 minutes

    90806 and 90818 — Individual psychotherapy 45-50 minutes

    90808 and 90821 — Individual psychotherapy 75-80 minutes
    90810 and 90823 — Interactive individual psychotherapy 20-30 minutes

    90812 and 90826 — Interactive individual psychotherapy 45-50 minutes

    90814 and 90828 — Interactive individual psychotherapy 75-80 minutes

    (+) New Code(s):

    90832 — Psychotherapy, 30 minutes with patient and/or family member

    • AMA time measurement 16-37 minutes

    90834 — Psychotherapy, 45 minutes with patient and/or family member

    • AMA time measurement 38-52 minutes

    90837 — Psychotherapy, 60 minutes with patient and/or family member

    • AMA time measurement 53-68 minutes

    +99354, +99355 or +99356, +99357 prolonged service codes (List separately in addition to code) — Use correct prolonged service code in addition to 90837 for services lasting longer than 90+ minutes.

    • +99354, +99355 — Outpatient or office setting
    • +99356, +99357 — Observation or inpatient setting

    Usage and Organization Tips:

    Prior to 2013, the provider would document and pick the code from the correct group using the following components: 

    • Patient presence
    • Face-to-face time with the patient
    • Place of service
    • Interactive complexity

    The codes were grouped together by:

    1. Place of service (office/outpatient vs. inpatient)
    2. Individual psychotherapy vs. Interactive individual psychotherapy

    Within each of these groups was the subgroup of codes with specific times:

    • 20-30 minutes
    • 45-50 minutes
    • 75-80 minutes

    Starting January 1, 2013 code selection will be based on the following components:

    • Time spent with patient and/or family member 

       

      • More times than not, the therapist will meet with the patient then meet with a family member for different reasons.
        • The procedures codes available did not necessarily reflect the true work or time involved leaving it difficult to accurately report.
    • Place of service no longer matters (office setting, outpatient setting, or inpatient setting).
    • Interactive complexity is a simple add on code which means the provider would report two procedure codes instead of one.

    PSYCHOTHERAPY FOR CRISIS

    (+) New Code(s):

    90839 — Psychotherapy for crisis; first 60 minutes

    +90840 — each additional 30 minutes (List separately in addition to code for primary service) 

    • Use 90840 in conjunction with 90839
    • Do not report 90839, 90840 in conjunction with 90791, 90792, 90832-90838, or other psychiatric services (or 90785-90899)

    Usage Tips:

    Psychotherapy for crisis definition — a complex life threatening problem requiring immediate treatment.

    Treatment will include:

    • Psychotherapy
    • Treatment team organization
    • Intervention treatment for patient safety and reduction of psychological trauma

    Patient assessment includes:

    • History of crisis
    • Mental status exam
    • Disposition

    Coding Tips:

    Time element is very important and is defined by the following for 90839 and 90840:

    • Total duration of face-to-face time with patient and/or family 
    • Providing crisis management
    • Time spent does not have to be continuous but must be on same date
    • Professional must devote full attention to the patient and cannot be providing services during the same time period
    • Patient must be present for all or some of service
    • Do not report with crisis codes on the same day as the following codes:
      • 90791, 90792 Evaluation codes
      • 90832, 90834, 90837 Psychotherapy codes
      • +90833, +90836, +90838 Psychotherapy add on codes
      • +90785 Interactive complexity
    • Report 90839 for the first 30-74 minutes
    • Report +90840 for each additional 30 minutes beyond 74 minutes
    • Report 90832 for 30 minutes or less

    PHARMACOLOGIC MANAGEMENT

    (-) Deleted Code(s):

    90832 — Pharmacological management, including prescription, use, and review of medication with no more than minimal medical psychotherapy

    (+) New Code(s):

    +90863 — Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services (List separately in addition to the code for primary procedure)

    Usage and Coding Tips:

    • Use 90863 with psychotherapy services only (e.g., 90832, 90834, 90837)
    • Code use is intended for qualified healthcare professionals who are not allowed to bill evaluation and management codes but have prescribing capabilities. (i.e., Prescribing psychologists)

    FAMILY OR GROUP PSYCHOTHERAPY SERVICES

    (-) Deleted Code(s):

    90857 — Interactive group therapy 

    (+) New Code(s):

    90846 — Family psychotherapy (without patient present)

    90847 — Family psychotherapy (conjoint psychotherapy) (with patient present)

    90849 — Multiple-family group psychotherapy

    90853 — Group psychotherapy (other than a multiple-family group) 

    Coding Tips:

    • To report interactive complexity in group psychotherapy service use +90875 in conjunction with 90853
    • To report interactive complexity provided with a family or multifamily group service report +90875 with 90846, 90847, 90849

    Resources

    1. Current Procedural Terminology CPT 2013 Professional Edition, American Medical Association
      • Current Procedure Terminology (CPT®) copyright
      • 2012 American Medical Association. All rights reserved.
      • CPT is a registered trademark of the American Medical Association 
    1. AMA Corrections Document – CPT ® 2013
    2. American Psychiatric Association CPT Coding Resources

      Crosswalk of 2012 CPT® Codes to 2013 CPT® Codes

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