Psychiatry Coding & Reimbursement Alert

Question: If a patient sees our psychiatrist to see if any changes in the drug regimen is to be done and then sees our psychologist for psychotherapy, will we have to bill an E/M service along with the add-on psychotherapy codes or should we report 90863 with psychotherapy codes?

Dallas Subscriber

Answer:It appears from your question that your psychiatrist is only performing medication management and not providing any counseling to the patient; your psychologist is providing the counseling subsequent to the psychiatrist’s medication management. Since your psychiatrist is allowed to claim E/M codes for medical services provided, including medication management, you can claim the adjustments to the drug regime or evaluation of a patient for medication with an appropriate E/M code attributed to the psychiatrist’s provider number. You’ll not use +90863 (Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services [List separately in addition to the code for primary procedure]) to report medication management performed by your psychiatrist, because this code is for use only by health care professionals who are not otherwise able to bill E/M codes.

If the psychiatrist performs the psychotherapy for the patient in addition to the medication management, you can report this portion of the service with the add-on psychotherapy codes, +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]), +90836 (Psychotherapy, 45 minutes…) or +90838 (Psychotherapy, 60 minutes…), depending on the time spent in providing the service.

However, if, as indicated, your psychiatrist only performed pharmacological management and the psychotherapy was performed by your psychologist, these will be two different services. You will report the service provided by your psychiatrist with the appropriate E/M code and report the service provided by your psychologist under his or her provider number with the CPT^® codes, 90832 (Psychotherapy, 30 minutes with patient and/or family member), 90834 (Psychotherapy, 45 minutes…) or 90837 (Psychotherapy, 60 minutes…), on the basis of time spent for the session. The different provider numbers associated with the different services should facilitate payment of both services in this situation.