Psychiatry Coding & Reimbursement Alert

Question: What is the difference between psychiatry codes 90801-90802 and 90804-90829?

South Dakota Subscriber

Answer: The first series of codes are diagnostic codes. For example, code 90801 describes a "psychiatric diagnostic interview examination." A psychiatrist generally provides this service during the initial phase of treatment to establish a diagnosis and a treatment protocol. The service includes a history, mental status assessment, and treatment plan formulation and may also include ordering and interpreting diagnostic tests as well as communication with family or other sources.

Psychiatric diagnostic code 90802 (Interactive psychiatric diagnostic interview examination using play equipment, physical devices, language interpreter, or other mechanisms of communication) is a similar service that is typically provided to children.

Codes 90804-90829 describe individual psychotherapy. You should choose the appropriate code based on where the psychotherapy session occurs, the type of psychotherapy, the amount of face-to-face time the psychiatrist spends with the patient, and whether the physician provides medical E/M services on the same date as the psychotherapy service.

Example: A psychiatrist provides insight-oriented psychotherapy for 20 to 30 minutes in his office without any medical evaluation and management of the patient. You would code the visit with 90804 (Individual psychotherapy, insight-oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient). But if he also provides medical evaluation and management in addition to insight-oriented psychotherapy, you would use 90805 (... with medical evaluation and management services).