Psychiatry Coding & Reimbursement Alert

Read our experts’ opinions on coding these scenarios.

Scenario 1: Use CPT® Time Rules

What to report: In this case scenario, you will have to report 90839, +90840. To determine the appropriate code that you will have to report for any crisis psychotherapeutic intervention, you will have to base your code choice using the CPT® time rules.

According to these rules, you will have to report 90839 (Psychotherapy for crisis; first 60 minutes) for the first 30-74 minutes of face-to-face service provided to the patient. Even though the descriptor for 90839 mentions time as first 60 minutes of service, you will use the same code even if your clinician provides a service that is more than 60 minutes but equal to or less than 74 minutes.

When the session lasts for more than 74 minutes but less than 105 minutes, you will use one unit of the add-on code +90840 (Psychotherapy for crisis; each additional 30 minutes [List separately in addition to code for primary service]) in addition to 90839 to capture the time spent beyond the first 60 minutes.

Scenario 2: Short Crisis Psychotherapeutic Situation

What to report: In this scenario, you will have to use the CPT® code 90832. According to CPT® time rules, you will use the 90839 when a crisis psychotherapy session lasts between 30-74 minutes of face-to-face service with the patient.

The CPT® time rules state that a minimum of 30 minutes of services should be provided in order to report 90839. In case the time involved in providing these services did not meet the minimum 30 minute time criterion, then you will have to report either 90832 (Psychotherapy, 30 minutes with patient and/or family member) or +90833 (Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service [List separately in addition to the code for primary procedure]), as appropriate, for the psychotherapy part of the services.

Scenario 3: Crisis Psychotherapy During a Psychotherapy Session

What to report: In this situation, you will have to only report 90839 for the services provided by your clinician, assuming the time threshold was met. You cannot report the initial psychotherapy service with any time appropriate psychotherapy code from the CPT® code range 90832-90838 if you are also reporting 90839.

According to CPT® guidelines, “Psychotherapy provided to a patient in a crisis state is reported with codes 90839 and 90840 and cannot be reported in addition to the psychotherapy codes 90832-90838.” 

Also, Correct Coding Initiative (CCI) edits bundle crisis management codes into non-crisis psychotherapy codes. These edits carry the modifier indicator ‘0,’ which indicate that you cannot break the code bundling under any circumstances. Thus, if you report 90839 with a code like 90832 or 90833, only the basic psychotherapy code (e.g. 90832) will be paid, if the payer is following the CCI edits. 

Since the focus of the visit turned from providing the usual psychotherapy session to crisis psychotherapeutic intervention as the patient turned suicidal, you will have to only report the appropriate crisis psychotherapy code for the session, assuming the time threshold was met. 

Scenario 4: Crisis Psychotherapy Complicated by Communication Problems

What to report: In the example described, you will have to report 90839, +90840x2. When a crisis psychotherapeutic session is complicated by communication issues, you cannot claim for additional reimbursement using the interactive complexity code, +90785 (Interactive complexity [List separately in addition to the code for primary procedure]) with crisis management codes.

You cannot report the add-on code +90785 with crisis management codes as any such crisis management situation is bound to have communication difficulties. The reason codes 90839 and +90840 are excluded from the use of this add-on code is because the need for 3rd party involvement is inherent in the use of these codes and therefore should not be billed separately. Usually, there is a need for third party involvement for such situations, and you cannot separately claim it using the add-on code. A parenthetical notation following code +90785 in CPT® explicitly states, “Do not report 90785 in conjunction with 90839, 90840, or in conjunction with E/M services when no psychotherapy service is also reported.”

CPT® time rules for crisis management say you have to use 90839 for the first 30-74 minutes of crisis psychotherapy, one unit of +90840 from 75-104 minutes, and another unit of +90840 from 105-134 minutes.