Psychiatry Coding & Reimbursement Alert

Question: One of our newly-appointed psychiatrists wants to perform group psychotherapy for patients. If he conducts these sessions on the same day on which he performs individual psychotherapy, can both the individual psychotherapy and group psychotherapy be reported on the same calendar date of service?

Kentucky Subscriber

Answer: You can report an individual psychotherapy code (such as 90832, Psychotherapy, 30 minutes with patient and/or family member) along with the group psychotherapy code 90853 (Group psychotherapy [other than of a multiple-family group]) on the same calendar date of service if your clinician performs both these services for a patient on the same date. However, these service codes are bundled, according to Correct Coding Initiative (CCI) edits.

Since the modifier indicator for these edit bundles is ‘1,’ you can overcome the edits by using a suitable modifier. The individual psychotherapy codes are the column 2 codes in the edit bundle with group psychotherapy codes. So, you will need to append a suitable modifier such as 59 (Distinct procedural service) to the individual psychotherapy code that you are reporting for the visit. You will need to append the modifier 59 as both the procedures were performed by your clinician for the same person on the same date of service and to let to know the payer that both the services are distinct and separately reimbursable.

Documentation: You will need to submit proper documentation to prove medical necessity of performing both the individual and the group psychotherapy for the person so that it supports the two services you are reporting.