Hint: The add-on code for interactive complexity is not a time-based code.
When your clinician experiences specific communication issues that complicate performance of selected psychiatric diagnostic or therapeutic services, you’ll need to factor in an add-on CPT® code, namely +90785, to reimburse for the extra time that your practitioner spent with the patient.
Coding scenario: Your psychiatrist uses play equipment to evaluate a patient for autism. Since the patient has communication disabilities, your clinician spends a considerable amount of time with him to complete his evaluation.
What to report: Since your clinician performed an evaluation of the patient that included a complete history, complete mental status examination, complete psychiatric and medical history of the patient and family, a review of systems, and ordering and interpreting diagnostic tests, neurobehavioral tests, and other evaluation questionnaires, you’ll use 90792 (Psychiatric diagnostic evaluation with medical services). Since there were communication difficulties during evaluation of the patient, you also report +90785 (Interactive complexity [List separately in addition to the code for primary procedure]) with 90792.
RVU factor: 90792 has 3.65 total non-facility RVUs with a Medicare payment of $124.18. +90785 has 0.14 total non-facility RVUs with a Medicare payment of $4.76. When an interactive complexity component is reported with 90792, you get paid $128.94 instead of $124.18.
Know When to Add up Interactive Complexity to Psychiatry Services
You can report +90785 when any of the following factors is present and increases the time that your practitioner spends on the patient, according to CPT®:
Caveat: You cannot use +90785 solely for any translation or interpretation services that your clinician might use during the delivery of a psychiatric service, according to CMS, as doing so amounts to higher beneficiary payments and copayments on the basis of ethnicity or disability that could implicate Title VI of the Civil Rights Act of 1964 or section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act, respectively.
Be Aware of Services That May Include an Interactive Component
You’ll need to be aware of what psychiatry services your clinician provides that may warrant you to report +90785 when it involves communication difficulties. The services that allow you to report an interactive component include the following:
Don’t forget: You will need to include documentation supporting your claim for +90785. This documentation should clearly explain the nature of the interactive complexity involved in the delivery of the psychiatric procedure.
Report Only One Unit of 90785 Per Session
Even though +90785 is reported to reflect the additional time your psychiatrist spends due to communication issues while providing a psychiatric service, keep in mind that this CPT® add-on code is not a time-based service, and you’ll only report one unit of the code for a session that is performed in a day.
When you report +90785 with a time-based service such as a psychotherapy service, the additional time that your clinician spent due to interactive complexity is reflected in the time spent in providing the timed service in total.
Example: Your psychiatrist typically conducts psychotherapy sessions for 30 minutes. When providing psychotherapy to a patient suffering from Asperger’s syndrome, your psychiatrist spends 45 minutes in the delivery of the psychotherapy session owing to communication challenges and due to the use of play equipment.
What to report: You’ll report 90834 for the session, as your psychiatrist spent a total of 45 minutes for the psychotherapy session instead of the usual time of 30 minutes, which you would have reported with 90832. You’ll also report +90785 as an add-on code to 90834. Since +90785 is not a time-based code, you’ll just add up the extra time spent by your clinician owing to interactive complexity to the time spent on psychotherapy to calculate the time spent during the entire session.
Note: "When reporting +90785 with a psychotherapy add-on code performed with an E/M service (i.e.+90833, +90836, or +90838), the amount of time spent providing interactive complexity services must relate to the psychotherapy service only," points out Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians. "In general, interactive complexity is not a factor for E/M services selection," adds Moore.
Don’t Report 90785 With These Psychiatry Services
You should be aware that not all psychiatry services will include a separately reportable interactive component that can be reported with the add-on code +90785. The services that don’t have a separately reportable interactive component include the following: