Psychiatry Coding & Reimbursement Alert

Question: During one of the psychotherapy sessions for a patient with depression, the patient expressed suicidal tendencies and our clinician had to perform emergency crisis psychotherapy intervention to prevent the patient from hurting himself. Should I report a psychotherapy code for the visit, or a crisis psychotherapy code or both the codes?

New York Subscriber

Answer: The codes for psychotherapy (90832-90838) and crisis management codes (90839, Psychotherapy for crisis; first 60 minutes and +90840, …each additional 30 minutes [List separately in addition to code for primary service]) face bundling according to Correct Coding Initiative (CCI) edits. These edits carry the modifier indicator ‘0,’ which indicate that you cannot break the code bundling under any circumstances. 

These edits are consistent with the CPT® guidelines preceding the psychotherapy codes. Those guidelines state, in part, “Psychotherapy provided to a patient in a crisis state is reported with codes 90839 and 90840 and cannot be reported in addition to the psychotherapy codes 90832-90838.” 

So, you cannot report the psychotherapy code and the crisis management intervention codes for the visit together under any circumstances. If you report these codes, together, your claim for the crisis management codes will be denied as they form the column 2 code for the edits.

Since the focus of the visit turned from providing the usual psychotherapy session to crisis psychotherapeutic intervention as the patient turned suicidal, you will have to only report the appropriate crisis psychotherapy code for the session. 

Even though the base psychotherapy for crisis code carries a specific time of 60 minutes, you may report this codes based on CPT® time rules. So, depending on time spent in the crisis management of the patient, you will have to report 90839 if the time spent on crisis management was 31-74 minutes. You report the add-on code +90840 with 90839 only when time reaches the 75th minute. When time crosses 105 minutes, you will use 90839 and +90840x2.

Reminder: The psychotherapy for crisis code 90839 can only be used once per day. For additional time beyond the first hour of service, you should use +90840. The face-to-face time spent providing services to the patient need not be continuous. However, your clinician cannot be providing services to any other patient during the same time period and should be involved in providing individual services to the particular patient.

Reimbursement tip: The crisis psychotherapy code 90839 will fetch you better reimbursement than 90837 (Psychotherapy, 60 minutes with patient and/or family member). According to the Medicare Physician Fee Schedule for 2014, 90839 will fetch you approximately $134.34 (RVU 3.75 x 35.8228) in the non-facility setting while a claim for 90837 will fetch you approximately $128.60 (RVU 3.59 x 35.8228) in the same setting.