+90838 CPT Code: Know Your Codes
There are two sets of psychotherapy codes. One set is the set of codes to report psychotherapy only i.e., CPT 90832- 30 minutes; CPT 90834-45 minutes; and CPT 90837- 60 minutes. While these are most frequently reported by social workers, psychologists and therapists, they can be reported by psychiatrists, psychiatric NPs, and PAs if medication management’s not performed at the same visit. These are time-based codes and do not differentiate by the type of psychotherapy or the location of the therapy. The second set of individual psychotherapy codes set are add-on codes i.e. CPT code 90833, CPT code 90836, and CPT code 90838.
The second set of individual psychotherapy codes set are add-on codes. When psychotherapy is done in the same encounter as an E/M service, there are timed add-on codes for psychotherapy that are to be used by psychiatrists to indicate both services were provided i.e., 90833 -30 minutes, 90836 – 45 minutes, 90838 – 60 minutes. Add-on codes are indicated by a plus sign. An add-on code is a CPT code that describes a service always performed in conjunction with the primary CPT code. For example, +90833 CPT code is used with the primary CPT code 90832, +90836 with 90834, and +90838 with 90837. These are billed by psychiatrists, psychiatric nurse practitioners, and psychiatric physician assistants.
+90838 Code Description
Use add-on code for Individual psychotherapy, insight-oriented, behavior modifying and/or supportive, 60 minutes with the patient and/or family member (time range 53 minutes or more), when performed with an evaluation and management service. As mentioned above add-on code 90838 can be used with primary CPT code 90837 (i.e., psychotherapy, 60 minutes with the patient).
Add-on CPT Codes 90833, 90836, 90838
- To report both an E/M code and a psychotherapy add on code, the two services must be significant and separately identifiable.
- The type and level of E/M service is selected first based upon the key components of history, examination, and medical decision making.
- Time may not be used as the basis of the E/M code selection.
Key Points for Accurate Coding
- Psychotherapy with medical evaluation and management services (formerly reported as 90805, 90807, 90809, 90811, 90813, 90815, 90817, 90819, 90822, 90824, 90827, 90829) are now reported with codes for E/M services plus a psychotherapy add-on code, +90833, +90836, and +90838.
- Code ‘exact’ time (in minutes) Actual Time Range (in minutes) 90832, +90833 30 16-37 90834, +90836 45 38-52 90837, +90838 60 At least 53
- Psychotherapy times are for face-to-face services with the patient and/or family member. The patient must be present for all or some of the service. In reporting, choose the code closest to the actual time (i.e., 16-37 minutes for 90832 and 90833, 38-52 minutes for 90834 and 90836, and 53 or more minutes for 90837 and 90838). Do not report psychotherapy of less than 16 minutes duration.
- If a patient is unable to communicate by any means, the interactive complexity codes should not be billed. This service is used in conjunction with codes for diagnostic psychiatric evaluation (90791, 90792), psychotherapy (90832, 90834, 90837), psychotherapy when performed with an evaluation and management service (90833, 90836, 90838, 99201-99255, 99304-99337, 99341-99350), and group psychotherapy (90853).
- Procedure codes 90832-90838 (psychotherapy for 30 to 60 minutes) – report the code closest to the actual time (i.e., 16-37 minutes for 90832 and 90833, 38-52 minutes for 90834 and 90836, and 53 or more minutes for 90837 and 90838. Procedure codes 90833, 90836 and 90838 are add on codes that should be used in conjunction with evaluation and management (E/M) codes 99201-99239, 99304-99337, 99341-99350.
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