Psychiatry Coding & Reimbursement Alert

Hint: Don’t overlook CCI edit bundles when reporting two codes together.

You will find that reporting a group psychotherapy session may not be very straightforward each time. You might be faced with scenarios wherein you might need to report other psychiatry codes for other same day services. In such cases, you might have to alter your reporting of the codes, depending on the situation.

Read the following four scenarios, and see if you can crack the coding for the different group psychotherapy situations that are elaborated.

Scenario 1: Same Day Psychotherapy with Group Psychotherapy

Your psychiatrist performs behavioral psychotherapy for a 46-year-old male patient who has been suffering from depression. The session lasts for 30 minutes. After this session, the patient gets into a group psychotherapy session with your psychiatrist. The group psychotherapy session lasts for another 30 minutes. What code(s) will you report for the services provided by your psychiatrist to this patient?

•  90832

•  90832, 90853

•  90832, 90853-59

•  90832-59, 90853

Scenario 2: Group Psychotherapy Coupled With Interactive Complexity

Your psychiatrist conducts a group psychotherapy session for ten patients with attention deficit hyperactivity disorder and has to communicate using play equipment with six of them due to communication issues. What code(s) do you report for this entire session?

•  90853

•  90853, +90785

•  90853x10, +90785

•  90853x10, +90785x6

Scenario 3: Group Psychotherapy With Separate Family Session

Your psychiatrist conducts a group psychotherapy session for four patients with ADHD. He then conducts a separate session with the parents and siblings of the patients. This group session with family members includes a total of 12 people. What code(s) do you report for the sessions held during that day by your clinician?

• 90853

• 90853x16

• 90853x4, 90849-59x4

• 90853x4, 90849-59x12

Scenario 4: Group Psychotherapy in a Partial Hospitalization Setting

Your clinician conducted a group psychotherapy session for seven Medicare patients who are part of a partial hospitalization program. The session lasted a total of 45 minutes. He encountered communication issues with three of these patients and needed to use play equipment to communicate with these three patients. What code(s) will you use to report the session held by your clinician?

• 90853x7, +90785x3

• G0410x4, G0411x3

• G0410x7, +90785x3

• G0410x7, G0411x3

Turn to page 27 for the solutions