Psychiatry Coding & Reimbursement Alert

Question: All the patients in our facility meet a clinical social worker once a week for psychotherapy and then meet our psychiatrist once a month for the regulation of their medications. When the patients meet our psychiatrist he spends about 30 minutes with each one of them. Even though this meets the requirements to report for 90805, many insurance companies pay out for just the monitoring of medications (90862). Tell me whether I need to bill out only 90862 or I can bill for 90805 as the time spent on the patient meets the guidelines for 90805?

Idaho Subscriber

Answer: One thing that you will need to focus on is what your psychiatrist did during the monthly visits in which he sees your patients. If during the visit, he is just performing monitoring of medications alone and does very little in terms of providing psychotherapy, then you cannot report your psychiatrist's services with 90805 (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; with medical evaluation and management services) even though the time spent on the patient meets the requirements of the code.

If your psychiatrist only performs monitoring of medications along with very minimal or no psychotherapy at all then it is best that you stick to reporting the services with 90862 (Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy). Minimal psychotherapy would be brief, supportive therapy to help patients cope with stresses. Also you should remember that the psychotherapy provided is not the actual focus of the visit. Although a typical pharmacological management session will take about 10 to 15 minutes, you stick with 90862 irrespective of the time spent on the patient only for drug monitoring.

If during the visit, your psychiatrist performs more than minimal psychotherapy (for about 20-30 minutes duration) along with medication management, then you can use 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) to report the visit. You can use 90805 only if your psychiatrist also performs evaluation of the patient to record the patient's history and proceeds to perform an examination. This will usually be done only if there is a significant change in the patient's current mental health status or if the patient is suffering from a new or previously undiagnosed condition.