Psychotherapy Codes
Major Changes for 2013
Mirean Coleman, LICSW, CT
© CPT copyright 2012. American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
©2013 National Association of Social Workers. All Rights Reserved.
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Purpose
• To provide an overview of the new psychotherapy
codes which became effective January 1, 2013
• To make clinical social workers aware of
psychotherapy codes available for use by them
• To help clinical social workers become HIPAA
compliant with electronic code transactions in
2013
©2013 National Association of Social Workers. All Rights Reserved.
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Revision Process
• The psychotherapy codes were last revised in
1998
• NASW was involved in the revision process
• CPT Editorial Panel developed a work group
• Work group consisted of the Academy of Child
and Adolescent Psychiatry, American Nurses
Association, American Psychiatric Association,
American Psychological Association, and NASW
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Why Change the Codes
Since 1998, mental health services changed
(1) Reduction in inpatient beds, creating large
volume of outpatient mental health services
(2) Work intensified in outpatient services
(3) Co-morbid conditions increased
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Deleted Codes
90801: Psychiatric Diagnostic Interview
90802: Interactive Psychiatric Diagnostic
Interview
90804, 90806, 90808: Individual Outpatient
Psychotherapy
90810, 90812, 90814: Interactive Individual
Outpatient Psychotherapy
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Deleted Codes
90816, 90818, 90821: Residential Individual
Outpatient Psychotherapy
90823, 90826, 90828: Interactive Individual
Outpatient Psychotherapy
90857: Interactive Group Psychotherapy
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Codes Without Changes
90845: Psychoanalysis
90846: Family Psychotherapy (without the patient
present)
90847: Family psychotherapy (conjoint
psychotherapy, with the patient present)
90849: Multiple-family group psychotherapy
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Codes Without Changes
90853: Group psychotherapy (other than of a
multiple-family group)
90880: Hypnotherapy
90889: Preparation of report of patient’s psychiatric
status, history, treatment or progress (other
than for legal or consultative purposes) for
other physicians, agencies, or insurance
carriers.
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Family of Codes Without Changes
• Health and Behavior Assessment and
Intervention Codes were not changed
• These codes identify services focusing on biopsychosocial factors affecting physical health
problems
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Family of Codes Without Changes
96150:
96151:
96152:
96153:
96154:
96155:
Health and behavior assessment
Reassessment
Health and behavior intervention, individual
Group (2 or more patients)
Family (with the patient present)
Family (without the patient present)
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Family of Codes Without Changes
Medical Team Conference Codes
(1) Face-to-face participation by three or more
licensed health care providers from
different health care specialties.
(2) Participants are actively involved in the
development and coordination of health
care services.
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Family of Codes Without Changes
99366: Medical team conference with
interdisciplinary team of health care professionals,
face-to-face with patient and/or family, 30 minutes
or more……….
99368: Medical team conference with
interdisciplinary team of health care professionals,
patient and/or family not present, 30 minutes or
more…….
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New Codes
•
•
•
•
•
Several new codes were developed
Individual psychotherapy codes were deleted
Services are for face-to-face services only
All settings are included
Evaluation and Management component was
separated in the diagnostic interview
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New Codes
90791: Psychiatric Diagnostic Interview
An integrated, bio-psychosocial
assessment, including history, mental
status, and recommendations
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Coding Tips for 90791
•
•
•
•
Can only be reported once a day
Can be used more than once if needed
Are only for the patient, and not the informant
Does not include psychotherapeutic services
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Other New Codes
• 90832: Psychotherapy, 30 minutes with patient
and/or family member
• 90834: Psychotherapy 45 minutes with patient
and/or family member
• 90837: Psychotherapy 60 minutes with patient
and/or family member
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Time factors for Codes
• Based on needs of patient, decide which time
frame is appropriate.
• Time factors for individual services are:
(1) 90832: 16 to 37 minutes
(2) 90834: 38 to 52 minutes
(3) 90837: 53 minutes are more
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Time Factor Recommendation
Follow the time specified in the code descriptor in
order to avoid possible overpayment requests
especially when an insurance company requests
documentation of the start and stop times of the
psychotherapy session.
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Time Coding Tip
When patient is seen beyond 90837, 60 minutes,
then a prolonged service code can be used if
patient is seen for a minimum of 90 minutes.
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Prolonged Service Codes
Prolonged Service Codes include
• 99354
Prolonged Service With Direct Patient
contact
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Coding Tips for 90832, 90834, 90837
• The psychotherapy session identified in these
codes is primarily with the patient, not the family
• The family is used to obtain information
• Psychotherapy concerned with the effects of the
patient’s condition on the individual being
interviewed is not reimbursable as part of the
clinical social worker’s services to the patient.
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Coding Tips for 90791,90832, 90834, 90837
• When using these codes, the patient should be
the primary receiver of psychotherapy services
• Clearly document this in the patient’s record to
avoid overpayment requests
©2013 National Association of Social Workers. All Rights Reserved.
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Interactive Complexity
• 90785 is an add-on code for interactive
complexity
• Report with 90791, 90832, 90834, 90837, and
90853
• Refers to communication factors that complicate
the delivery of psychiatric procedures.
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Interactive Complexity
Common factors include:
(1) More difficult communication with discordant or
emotional family members
(2) Engagement of young and verbally undeveloped
or impaired patients
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Interactive Complexity
Typical patients are:
1. Third-parties such as parents, guardians, and
other family members
2. Interpreters, language translators
3. Agencies
4. Court officers
5. Schools involved in their psychiatric care
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Interactive Complexity
Factors present with patients who:
(1) Have other individuals legally responsible
for their care
(2) Request others to be involved in their care
during the visit
(3) Require the involvement of other third
parties
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Interactive Complexity
Interactive complexity procedures may be reported
when one of the following is present:
(1) The need to manage maladaptive
communication among participants
complicates delivery of care.
(2) Caregiver emotions or behavior that interferes
with the caregiver’s understanding and ability
to assist with the treatment plan
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Interactive Complexity
(3) Evidence or disclosure of a sentinel event and
mandated report to third-party with the initiation of
discussion of the sentinel event and/or report with
patient and other interview participants
(4) Use of play equipment, other physical devices,
interpreter, or translator to communicate with the
patient to overcome barriers to the therapeutic or
diagnostic process
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Interactive Complexity
Use with a patient who
(1) Is not fluent in the same language as the
clinical social worker
(2) Has not developed, or has lost, either the
expressive language communication skills to
explain his/her symptoms and response to
treatment
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Psychotherapy for Crisis
• A new service identified through coding
• An urgent assessment and history of a crisis
state, a mental status exam, and a disposition.
• Presenting problem is life threatening or complex
and requires immediate attention
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Psychotherapy for Crisis
Treatment includes
(1) Psychotherapy
(2) Mobilization of resources to defuse the crisis
and restore safety
(3) Implementation of psychotherapeutic
interventions to minimize potential psychological
trauma
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Psychotherapy for Crisis
• 90839
Psychotherapy for crisis, first 60 minutes
• 90840
Each additional 60 minutes
This is an add-on code. List separately
in addition to 90839
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Coding Tips for 90839 and 90840
• Must devote your full attention to the patient
• Cannot provide services to another patient during
the same time period
• Patient must be present for all or some of the
service
• Report total face-to-face time with patient and
family even if the time is not continuous
• Can only report once a day
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Time Factors for 90839 and 90840
• 90839: Psychotherapy, 60 minutes
30 to 74 minutes. Cannot use this code
if service is less than 30 minutes.
Instead, use 90832
• 90840: Can only add on to 90839 if crisis is
beyond the first 74 minutes.
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Payment for New Codes
• CMS assigned interim values to the new codes
• This was done because the survey process of the
psychotherapy codes is incomplete
• We may not know until 2014 what the permanent
rates will be
• The interim values set by Medicare has impacted
the rates set by other insurers
©2013 National Association of Social Workers. All Rights Reserved.
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Payment for Codes
• Codes to be surveyed are:
(1) 90839 Psychotherapy for crisis: carrier-priced
(2) 90840 Psychotherapy for crisis: carrier-priced
(3) 90785 Interactive Complexity: carrier-priced
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Advocacy for Codes
NASW continues to advocate for clinical social
workers in the coding process
Will participate in the survey process in February 2013 to
determine work and practice expense values for 90839,
90840 and 90785
Clinical social workers are encouraged to participate
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Questions and Answers
Additional questions can be answered at “An Hour With Psychotherapy
Codes: Questions and Answers.” It will be held on Wednesdays beginning January
23, 2013 through April 24, 2013 from 12:00 pm to 1:00 pm EST. There is no fee for
this teleconference which is opened to NASW members.
Name:
Teleconference Number:
Participate Passcode:
Psychotherapy Codes
866-454-4206
488595
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