Psychiatry Coding & Reimbursement Alert

Hint: Be careful of situations which don’t meet CPT® time requirements.

Reporting crisis psychotherapy sessions is not as simple as it seems. You will sometimes have to alter your reporting of the codes depending on the situation.

Read the following four scenarios, and see if you can decipher the right codes to report for the different crisis psychotherapeutic situations described.

Scenario 1: Use CPT® Time Rules

Your psychiatrist is called upon for emergency crisis intervention of a patient suspected to be suicidal. The patient is an established patient who is under the care of your psychiatrist for bipolar disorder, with the most recent episode depressed. Your clinician performs crisis psychotherapy to alleviate the suicidal tendency. He spends a total of 75 minutes time with the patient. Which of the following code(s) will you report for the services provided by your psychiatrist?

1) 90839
2) 90839, +90840
3) 90839, +90840x2
4) 90839, +90785

Scenario 2: Short Crisis Psychotherapeutic Situation

A 35-year-old male patient is reviewed by your psychiatrist after he showed undue signs of aggression towards his office colleague. Your clinician has been called upon for crisis interventional psychotherapy. The patient was previously undergoing psychotherapy sessions with your psychiatrist for symptoms of delusional disorder. Your clinician spends a total of 24 minutes with the patient. Which of the following code(s) will you report for the crisis management of the patient by your psychiatrist?

1) 90832
2) 90839
3) 90839, +90840
4) 90832, +90840

Scenario 3: Crisis Psychotherapy During a Psychotherapy Session

A 40-year-old male patient visits your psychiatrist for his scheduled psychotherapy session. The patient is suffering from depression and anxiety (dysthymia) and has been under the care of your clinician for about 4 months. During the visit, the patient expresses grief over how his wife has been neglecting him suddenly, and he felt that she wanted to leave him. Then he suddenly produced a small kitchen knife and attempted to cut himself. Your clinician succeeded in restraining him and performed crisis psychotherapeutic interventions. Which of the following code(s) will you report for the session?

1) 90832
2) 90839
3) 90832, 90839
4) 90832, 90839, +90840

Scenario 4: Crisis Psychotherapy Complicated by Communication Problems

Your clinician visits a patient for crisis psychotherapeutic management as the patient attempted to slash himself with a pen knife. The patient is extremely agitated and appears aggressive and had to be restrained using belts to prevent him from hurting himself or anyone attending to him. He refused to calm down and was extremely uncooperative and would not speak or listen to your psychiatrist. Owing to this, your clinician had to face severe difficulty in communicating with the patient. The crisis psychotherapeutic session lasted for about 120 minutes. What code(s) will you report for this session performed by your psychiatrist?

1) 90839, +90840
2) 90839, +90785, +90840
3) 90839, +90840x2
4) 90839, +90785, +90840x2.