CPT® 2013 Psychotherapy Better Describe Practice

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In Coding/Billing Newsletter
December 28, 2012
23 Comments
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by Cindy Harms, M.Ed., CPC-I, CPC-H

In 2013, CPT® codes for psychotherapy have changed to more accurately describe the practice of psychology:

• Codes for diagnostic evaluation and psychotherapy can be used in any setting; separate codes are no longer available for outpatients and inpatients.

• Add-on codes should now be used to describe interactive complexity services and pharmacologic management.

• Codes are now available to describe psychotherapy for crisis situations.

The CPT® codes for psychoanalysis, family psychotherapy (with and without the patient), multifamily group psychotherapy, and group psychotherapy have not changed from 2012.

 2012-2013 Crosswalk for CPT® Codes for Psychologists

2012                           2013

90801                        90791

90804                        90832

90806                        90834

90808                        90837

90810-90815            90832, 90834, 90837 and +90785 as appropriate, based on length of session

90816                        90832

90818                        90834

90821                        90837

90823- 90829           90832, 90834, 90837 and +90785 as appropriate, based on length of session

90845                        90845

90846                        90846

90847                        90847

90849                        90849

90853                        90853

90857                        90853 and +90785

90862                        +90863 (with principal psychotherapy codes 90832, 90834, and 90837)

The Centers for Medicare and Medicaid Services (CMS) has announced the 2013 payment rates for the new 2013 psychotherapy CPT® codes as part of the final Medicare fee schedule. Psychologists should check the policies of private managed care and other insurance companies for new policies on coverage and billing for services related to these new codes.

Look for more information on additional, new-for-2013 psychotherapy codes next month.

23 Responses to “CPT® 2013 Psychotherapy Better Describe Practice”

  1. Sue Korus says:

    The new CPT codes affect psychiatrists also. There is no crosswalk code for 90862 for psychiatrists; therefore, an appropriate E/M code must be used.

    In addition, when evaluation and management services and psychotherapy are provided in the same patient encounter, there are three add-on codes for the psychotherapy portion of the encounter. They are +90833, +90836, +90838 and must be used with the appropriate E/M code which is selected based on the key components of history, exam, and medical decision-making, not time.

    It should also be noted that the time requirements for the psychotherapy codes now follow CPT convention for time, i.e. for 90804 was 20-30 minutes of face-to-face time; 90832 is from 16-37 minutes.

  2. William O'Brien says:

    My question pertains to Outpatient Revenue codes for the psychiatrists performing the E/M coding…would they be your standard 983 pro and 510 tech..or would they fall under the Psych revenue codes as 961 pro 919 tech…

    thanks Bill

  3. Donna Susnjara says:

    I work with a clinical psychologist who provides trauma therapy for some of her patients. She was billing old CPT 90808 for her 90-minute sessions. The crosswalk points to new CPT 90837, but it’s description is for 60 minutes. The only add-on code I found was CPT 99354 and it can only be used with E/M codes for prescribing providers. I would appreciate any suggestions on how to bill for the additional time for our trauma therapy sessions.

  4. Sonja Haleyl says:

    Sue,
    Are all the other coding changes the same for psychiatrists?

  5. Quin Buechner says:

    Sue correctly pointed out that the new 90863 is not to be used by those who can use the E&M codes. She also noted, and I would emphasize, that there is no real crosswalk for 90862(see second green note under the code). As for the trauma Doc, I’d suggest the Psychtherapy in Crisis codes if done emergently which is suggested by the trauma situation. Otherwise, 90837 with prolonged services is your choice. The codes are to be used by psychiatrists and seem to be more aimed at them then other Mental Health professionals

  6. clair callaway says:

    To Donna Susnjara:
    You are correct. To bill 90 minutes of psychotherapy you would use the following codes:
    90837
    +99354
    The AMA published the Errata for 2013 and the Prolonged Codes were on it. Below is a copy of it for you.
    Evaluation and Management
    Prolonged Services
    Prolonged Service with Direct
    Patient Contact
    99354 Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour (List separately in addition to code for office or other outpatient Evaluation and Management service)
    (Use 99354 in conjunction with 90837, 99201-99215, 99241-99245, 99324-99337, 99341-99350) 
    99355 each additional 30 minutes (List separately in addition to code for prolonged service)
    (Use 99355 in conjunction with 99354)
    99356 Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; first hour (List separately in addition to code for inpatient
    (Use 99356 in conjunction with 90837, 99218-99220, 99221-99233, 99251-99255, 99304-99310) 
    99357 each additional 30 minutes (List separately in addition to code for prolonged service) Evaluation and Management service)
    (Use 99357 in conjunction with 99356)
    Revise the prolonged services codes 99354, 99356 to include 90837 to allow the reporting of extended psychotherapy with codes 99354-99357.

  7. Seana says:

    I am a little more confused now, can psychiatrists cannot report the 90791, 90832, and 90863?

  8. Gina says:

    When a Psychiatrist see a patient and does RX management why would he bill an E/M and not a psychotherapy code with a add on 90863?

  9. Melanie says:

    What should a provider do if they see a patient for less than 30 minutes? Bill a 99212?

  10. Lori M says:

    A 99212 is based on the average time of 10 minutes if you are looking at time. The decision making is straightforward, with a problem focused HPI, for a 99212 code. I think you have to look at the documentation to make that decision. Was the whole visit based on time? I don’t code psych, but I think you would base those visits on either the actual time that was spent or the 2 of 3 for the E/M.
    Any other thoughts out there?

  11. Nicole E. says:

    If a provider has a special X license to perscribe suboxone but not a Psychiatrist what code would be appropriate to use when seeing pts for medication management since 90862 is no longer available??

  12. Kathy D says:

    One of our mental health carriers is requesting psychiatrists use M0064 in lieu of the 90862. I see that BCBSM, Blue Care Network and WPS Medicare all have that code in their fee schedules. Does anyone have any experience with that code?

  13. Donna says:

    Does anyone have good case scenarios to when to use 70972 and 70972 with 70985?

  14. Donna B says:

    Does anyone have good case scenarios to when to use 90791, 90792with 90785?

  15. Suzanna Bennett says:

    The e/m codes are not time based when it comes to Med Management. I codes them all day long for an outpatient psych facility, and have been to a couple of seminars regarding the issue, and this is what everyone says, plus we’ve been getting paid this way. It’s all about the documentation, not the time spent.

  16. Domenic Tamborriello, LMSW says:

    What is the diagnostic code that replaces F43.23? What is the procedure code for 90 minute therapy sessions?

  17. Lana says:

    Does anyone know if you can use codes 99354-99357, in conjunction with 90838

  18. Mike LPC,LISAC says:

    I am looking for an alternative code for Group Therapy 90853 to address experiential trauma work I’m facilitating in 3-day, group settling. Currently using 90853 for outpatient clients via contract so can’t be re-used.
    I’ve considered Add On 90785 to 90853 (anyone know about this), but not sure about feasibility. Is anyone familiar with Cognitive Rehabilitation 97770? Can this be used in group setting?

  19. Kristine says:

    when billing a 99215 with 90833 does the 99215 need a modifier

  20. Susan Ponto says:

    Any suggestions on how to bill for a 90 minute session to Medicare? Rendering provider is an LCSW. Medicare denied claim submitted with CPT codes 90837 + 99354, the later not covered when rendered by this provider type. Crisis code(s) would not apply.

  21. Kristine says:

    Can someone please help me. when billing a 99215 with 90833 does the 99215 need a modifier???? I have heard that this is the best website to ask questions on but I am not getting any reply’s. Please help!!

  22. Deneil says:

    When using 90832 do you need a modifier to add 90863?

  23. Adam says:

    Does anyone know what the documentation requirements for a clinical psychologist for cpt 90791?

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