Psychiatry Coding & Reimbursement Alert

Question: When our psychiatrist sees a young patient, he’ll generally perform the evaluation of the patient over several visits. He will initially see the child’s parents in one session and then in subsequent sessions, he will evaluate the child using various play equipment. My question is what codes need to be used to report the initial visit in which the parents of the child are queried over history and other assessments are made using questionnaires. Can I use 90846 or 90847 to report these services?

Michigan Subscriber

Answer: You cannot use 90846 (Family psychotherapy [without the patient present]) or 90847 (Family psychotherapy [conjoint psychotherapy] [with patient present]) for an evaluation service provided in which the parents of the child were involved. Each of these codes is for a psychotherapy service that is directed towards the family of the patient to better understand the patient’s problem and how family interactions will affect or benefit the patient to cope with the condition.

When your psychiatrist performs an evaluation of the patient and the initial visit assesses the patient through his/ her parents, you’ll have to report this service using 90791 (Psychiatric diagnostic evaluation), which includes communication with family or other sources. In fact, the guidelines preceding code 90791 in CPT^® notes that, in certain circumstances, one or more other individuals (e.g. family members) may be seen in lieu of the patient. In the past, some payers would allow you to only report one unit of psychiatric diagnostic evaluation code per patient. Now, CPT^® guidelines have been revised to clarify that you may claim for more than one unit of 90791 or 90792 (Psychiatric diagnostic evaluation with medical services) if the psychiatric diagnostic evaluations extends beyond one session, as long as the sessions are on different dates.

So, when your psychiatrist performs an evaluation of a patient in multiple sessions on different days, you can report more than one unit of 90791 or 90792. If you are reporting the sessions with E/M codes, you’ll have to use the appropriate E/M codes to describe the visits based on the key components used in choosing the codes.