Psychiatry Coding & Reimbursement Alert

Question: One of our psychiatrists is performing psychotherapy sessions which last longer than what is stipulated in 90837. We were billing out 90832 along with 90837. However, our claim for 90832 is being denied. Should I omit the extra time spent during the session and only bill out 90837? This would mean loss of lot of revenue for our practice. What should we do?

New Jersey Subscriber

Answer:  First and foremost, you need to check if your psychiatrist concentrated on performing psychotherapy during the entire session or if some time was spent on performing an evaluation and management or a pharmacological management. If such is the case, only the time spent for providing psychotherapy should be accounted for while calculating the appropriate code to use for reporting the psychotherapy part of the service.

If your clinician performed psychotherapy for the entire amount of time that you have described in your question, you cannot report the additional time your clinician spends in performing the session with another psychotherapy CPT® code such as 90832 (Psychotherapy, 30 minutes with patient and/or family member). In such a case, your claim for the 90832 will be denied.

So, in such a case, you’ll have to report 90837 (Psychotherapy, 60 minutes…) as this is the CPT® code that is available to report the longest duration while providing psychotherapy. To report the additional amount of time spent on performing the session, you are allowed to report the prolonged services code, +99354 (Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour [List separately in addition to code for office or other outpatient Evaluation and Management service]).

Since it is not a norm for clinicians to perform extended sessions for performing psychotherapy, you’ll have to provide adequate documentation to show medical necessity of performing such a long session for a patient. If your clinician is in the habit of performing such long sessions for each and every patient, you might be opening your practice for an audit.

Reminder: You are allowed to report the prolonged services add-on code +99354 only when the time spent by your clinician in providing psychotherapy extends beyond 90 minutes. If the session length is lesser than 90 minutes, you are only allowed to report 90837.