Psychiatry Coding & Reimbursement Alert

Question: Recently, I was going through CCI edits and I observed that prolonged services codes are allowed with 90837 but cannot be reported with the add-on code +90838. However, since prolonged services codes can be reported with an E/M code, is it possible to report an extended psychotherapy with E/M session by using a prolonged service code?

California Subscriber

Answer: You are correct in your observation that a prolonged service 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]) can be used for extended psychotherapy sessions that are performed beyond the duration of 90 minutes. 

You are also correct in your observations that a prolonged service code can only be used with 90837 (Psychotherapy, 60 minutes with patient and/or family member) and not with the add-on code, +90838 (…when performed with an evaluation and management service [List separately in addition to the code for primary procedure]). Correct Coding Initiative (CCI) edits are in place with the modifier indicator ‘0,’ which means you cannot use a prolonged service code with +90838. CPT® guidelines preceding the psychotherapy codes are very explicit on this point and state, in part, “Prolonged Services may not be reported when psychotherapy with E/M (90833, 90836, 90838) are reported.”

Even though a prolonged service code can be used in conjunction with an E/M code, you cannot typically use it with an E/M code that you are reporting as a primary service along with psychotherapy. Since the session was extended because of a longer than normal psychotherapy session and not because of the evaluation service, you cannot claim for additional compensation by using the add-on code with the E/M code that you are reporting.