Psychiatry Coding & Reimbursement Alert

Hint: Train your sights on CCI when reporting two sessions together.

When trying to report time spent by your psychiatrist counseling the family members of a patient, you will have to be able to discern whether to report a family therapy code or an individual psychotherapy code. You will also need to understand whether to include time spent with the family into the individual psychotherapy code or to report it separately.

Read the following four scenarios and see if you can crack the coding for the different family counseling situations that are elaborated.

Scenario 1: Individual Psychotherapy vs. Family Therapy

Your psychiatrist counsels the family members of a patient who is suffering from bipolar disorder. He discusses how family behavior can help the patient overcome his problems and improve the outcome from psychotherapy. He also discusses how the patient is coping with his problems and how they can help him in getting better. He spends 20 minutes speaking with all of the four family members. The patient is present with the family members during the session. What code can be used to report this session with the family members?

    1)     90832
    2)     90846
    3)     90847
    4)     90849

Scenario 2: Family Session During Initial Evaluations

Your psychiatrist is performing an initial evaluation of a patient. The patient is suffering from mood swings, irritability, and grandiose thoughts. Your clinician also met up with the patient’s family members and queries about the patient’s condition and his previous medical and family history with the family members. The patient was not present during the session with the family members. What code(s) should you report for this initial diagnostic evaluation of the patient? 

    1)     90792
    2)     90792x2
    3)     90792, 90846
    4)     90792, 90847

Scenario 3: Group Session with Family Members

Your psychiatrist meets up with family members of five patients suffering from depression. He talks to all these family members and advises them about how to cope with the patient’s condition and how their behavior can help the patient in showing improvements. He also tells them about the importance of taking the prescribed medications on time and to ensure that the patients do not miss out on their scheduled medications. The total number of family members during the session was 13. The patients were not present during the session with the family members. What code(s) should you report for this session with the family members of the patients?

    1)     90853x5
    2)     90849
    3)     90849x5
    4)     90849x13

Scenario 4: Same Day Individual and Family Therapy Session

Your psychiatrist performs psychotherapy (duration 30 minutes) for a patient suffering from depression. Suspecting that the patient has not been following proper prescribed medication regimen, your clinician counsels the patient’s family members about the importance of following the prescribed medications. He counsels on how they can regulate whether or not the patient is following the prescribed regimen so that there can be an improvement in the patient’s condition. The patient was not present during the session with the family. He spent another 20 minutes with the patient’s family members. What code(s) can you report for the session spent with the patient and his family members?

    1)     90834
    2)     90846
    3)     90832, 90846-59
    4)     90832-59, 90846