Psychiatry Coding & Reimbursement Alert

Question: Our psychiatrist provides basic psychotherapy to a group of about 7 to 10 patients on a regular basis. These patients are mostly covered by Medicare and are part of partial hospitalization programs in the psychiatry facility of our hospital. Please tell me whether or not I can report these services using 90853 with the place of service being 52 as one of my colleagues is of the opinion that 90853 cannot be used over here.

Alabama Subscriber

Answer: When your psychiatrist provides group therapy to a group other than multiple family groups, you can report the services using 90853 (Group psychotherapy [other than of a multiple-family group]). Your colleague is right in pointing out that 90853 cannot be used to report group psychotherapy sessions provided to Medicare patients in a partial hospitalization program setting. Code 90853, along with other group psychotherapy codes such as 90849 (Multiple-family group psychotherapy) and 90857 (Interactive group psychotherapy) became invalid for group psychotherapy sessions performed in a partial hospitalization program setting on January 1, 2009. That is when the G codes described below became effective.

In the circumstance that your psychiatrist is providing psychotherapy sessions to a group in a partial hospitalization program setting, you will need to use the HCPCS code G0410 (Group psychotherapy other than of a multiple-family group, in a partial hospitalization setting, approximately 45 to 50 minutes) or G0411 (Interactive group psychotherapy, in a partial hospitalization setting, approximately 45 to 50 minutes) as appropriate to describe the services performed.

You are right in placing place of service as 52 (Psychiatric facility-partial hospitalization) for a partial hospitalization program setting. You should provide adequate documentation that all the guidelines that satisfy reporting the procedure codes were followed.

Reminder: You should also remember that any group activities like art classes, motion therapy, music therapy, eating together, excursions, or other recreational activities should not be reported using the group therapy codes. These codes should only be used for counseling and psychotherapy provided by your psychiatrist or any other qualified staff who are authorized by state statute to provide the services mentioned.