Service-specific Coding Guidelines for Psychiatry and Psychology Services
Coding for Psychiatry and Psychology Services
Individual psychotherapy CPT codes should be used only when the focus of treatment involves individual psychotherapy. Psychiatric service CPT codes should not be used when other CPT codes such as an evaluation and management (E/M) service or pharmacological codes are more appropriate. Let’s discuss service-specific coding guidelines for Psychiatry and Psychology services.
Psychiatric Diagnostic Interview Examination (90791, 90792)
- A psychiatric diagnostic evaluation or a psychiatric diagnostic evaluation with medical services can be conducted once, at the onset of an illness or suspected illness. The same provider may repeat it for the same patient if an extended break in treatment occurs if the patient requires admission to inpatient status for a psychiatric illness, or for a significant change in mental status requiring further assessment.
- This contractor considers an extended break as approximately 6 months from the last time the patient was seen or treated for their psychiatric condition. A psychiatric diagnostic evaluation may also be utilized again if the patient has a previously established neurological disorder or dementia and there has been an acute and/or marked mental status change, or a second opinion or diagnostic clarification is necessary to rule out additional psychiatric or neurological processes, which may be treatable.
- An E/M service may be substituted for the initial interview procedure provided required elements of the E/M service billed are fulfilled. E/M services require, in addition to the interview and examination, the provision of a written opinion and/or advice. E/M CPT codes do not include a psychotherapy service.
CPT Codes 90832-90838 represent Psychotherapy
Psychotherapy without medical evaluation and management services are reported as 90832, 90834 and 90837. Psychotherapy with medical evaluation and management services are reported with codes for E/M services plus a psychotherapy add-on code (90833; 90836; 90838). For psychotherapy sessions lasting longer than 90 minutes, reimbursement will only be made if the report is supported by the medical record documenting the face-to-face time spent with the patient and the medical necessity for the extended time.
- CPT Codes 90846 and 90847 represent family psychotherapy services for the treatment of mental disorders. They should not be used when the service performed is taking a family history or E/M counseling services. E/M counseling services should be coded with the appropriate E/M CPT code according to the time involved. Family counseling does not include the supervision of or therapy with professional caretakers or staff.
- CPT code 90853 represents group therapy. When medically indicated, the interactive complexity add-on code (+90785) may be billed in conjunction with this code.
- CPT Code 90839 is for the psychotherapy crisis for the first 60 minutes and code 90840 is for each additional 30 minutes. These codes are reported by themselves and may not be reported with 90791, 90792, 90832-90838, 90785-90899.
Medicare does not cover biofeedback for the treatment of psychosomatic disorders CPT codes 90885, 90887, 90889 are considered incidental services and are not separately payable.
Additional Coding Guidelines
- To report both E/M and psychotherapy, the two services must be significant and separately identifiable.
- A separate diagnosis is not required for the reporting of E/M and psychotherapy on the same date of service.
- The site of service is not applicable to psychotherapy. Psychotherapy codes are payable in all settings.
- CPT Code 90853 should also not be billed more than once per day for the same beneficiary unless he/she has participated in a separate and distinct group therapy session. In the infrequent event that a patient has a separate and distinct individual psychotherapy and group therapy session in one day, modifier -59 should be appended to the CPT code for the second session.
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