Psychiatry Coding & Reimbursement Alert

Hint: Watch for situations where you need to look for edit bundles.

Go through the following four scenarios, and see if you can select the right codes to report for these common psychotherapeutic situations. You can check your answers in the related article in this issue. 

Scenario 1: Understand CPT® Time Rules For Appropriate Psychotherapy Code Selection

Your psychiatrist performs behavioral psychotherapy for a 38-year-old male patient who has been suffering from depression. The patient had been prescribed anti-depressants, and he complains that he has been suffering from some adverse effects from taking the medications. The psychotherapy session lasts for 35 minutes, the medication management performed takes 10 minutes, and your clinician documents the time taken for the entire session as 45 minutes. Which of the following code(s) will you report for the services provided by your psychiatrist?

1) 90832
2) 99212, 90832
3) 99212, +90833
4) 99212, +90836

Scenario 2: Family Counseling With Psychotherapy

Your psychiatrist performs a scheduled psychotherapy session for a 36-year-old female patient suffering from anxiety and depression. The patient is accompanied by her husband, who is present with her for the entire session. At the end of the session, your clinician speaks to the patient’s husband and discusses the treatment, the results of the treatment, and future goals that he has planned to help the patient overcome the problems that she has been facing. Your clinician spent 30 minutes with the patient and then spoke to the husband for 10 minutes. Which of the following code(s) will you report for the services provided by your psychiatrist?

1) 90832
2) 90834
3) 90832, 90847
4) 90834, 90847

Scenario 3: Psychotherapy Ending in Crisis Management

A 25-year-old male patient arrives at your psychiatrist’s office for his scheduled psychotherapy session. He has been previously diagnosed with schizophrenia and has been on anti-psychotic medications. During the session, the patient becomes distraught  and tells your clinician that he (your clinician) has been conspiring with the patient’s family members and has made plans to finish him off. The patient grabs a letter opener on your clinician’s desk  and begins to threaten to hurt him and then to kill himself. Your clinician manages to restrain him and then performs crisis psychotherapeutic management. Your clinician had completed 20 minutes of the scheduled 45 minute session and then conducted about 30 minutes of crisis management. Which of the following code(s) will you report for the session?

1) 90832
2) 90834
3) 90839
4) 90832, 90839

Scenario 4: Reporting a Prolonged Psychotherapy Session

Your psychiatrist performs a scheduled psychotherapy session for a 32-year-old male patient. Before beginning the session, your clinician checks the patient for a change in mental status and also performs medication management, as the patient’s wife has informed your clinician that her husband has not been taking his medications properly. Owing to these changes, your clinician extends the duration of the psychotherapy session. The total duration of the psychotherapy session takes 90 minutes to complete. The mental status examination and medication management took 15 minutes. Which of the following code(s) will you report for the session?

1) 90837
2) 90837, +99354
3) 99213, +90838
4) 99213, +90838, +99354