Psychiatry Coding & Reimbursement Alert

Question: Our psychiatrist recently assessed a five-year-old boy for autistic disorder. He performed comprehensive history recording, examination, review of systems and used play equipment to assess and communicate with the child to overcome difficulties in communication. I am reporting 99204 for the session conducted with the child and the family members. However, since our psychiatrist used play equipment to overcome the communication issues with the child, can I also use add-on code +90785 to compensate for the extra time and effort spent?

Michigan Subscriber

Answer: The answer to this lies in whether or not your psychiatrist performed any other service during the same session. If during the session, your psychiatrist also performed psychotherapy, you can then claim for the interactive complexity component using +90785 (Interactive complexity [List separately in addition to the code for primary procedure]). You’ll have to remember that +90785 is used as an add-on code for the psychotherapy aspect of the service and not as an add-on code to the E/M component of the service.

So, in this scenario, you’ll report 99204 as the primary service, the psychotherapy component such as +90833 (Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service [List separately in addition to the code for primary procedure]) for the psychotherapy component and +90785 for the interactive complexity.

However, if your psychiatrist only performed an evaluation and management face-to-face service with the patient and his family members, you cannot claim for the interactive complexity even though your clinician had communication difficulties with the patient. The interactive complexity component is strictly to be used only with psychiatry codes and cannot be used for any other codes.

Reminder: If time spent was significantly higher due to the interactive complexity, you can try using prolonged services code such as +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]) as an add-on code to 99204. However, you’ll have to provide documentation to support your claim for the add-on code or else it will be rejected.