Psychiatry Coding & Reimbursement Alert

Question: I was just going through the new codes that have been introduced for 2013. I see that there is a plus code for interactive complexity. Can you help me by letting me know when this code can be used and what will be the primary codes that I will have to be using them with?

Wichita Subscriber

Answer: There have been many changes to the way you will be reporting psychiatry codes for services performed after Jan.1, 2013. You are right about the new code that has been introduced for reimbursing the time and effort spent on interactive complexity, which refers to specific communication factors that complicate the delivery of a psychiatric procedure.

Examples include when the patient that your clinician is treating is not able to communicate directly (e.g. needs an interpreter or other third party to facilitate communication) or has lost the ability to communicate for some reason. In such a case, you will use the new add-on code +90785 (Interactive complexity [List separately in addition to the code for primary procedure]).

You can use +90785 as an add-on code when your clinician experiences communication difficulties during a psychiatric diagnostic evaluation, during psychotherapy or during group psychotherapy. So, you can use this code with the following set of codes:

Codes for psychiatric diagnostic evaluation, namely, 90791 (Psychiatric diagnostic evaluation) and 90792 (Psychiatric diagnostic evaluation with medical services)

Codes for psychotherapy such as 90832 (Psychotherapy, 30 minutes with patient and/or family member), 90834 (Psychotherapy, 45 minutes…) and 90837 (Psychotherapy, 60 minutes…)

Add-on codes for psychotherapy that you will report with an E/M code 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]), +90836 (Psychotherapy, 45 minutes…)and +90838 (Psychotherapy, 60 minutes…)

Group psychotherapy code such as 90853 (Group psychotherapy [other than of a multiple-family group])

Reminder: Check your CPT^® manual to learn what guidelines need to be followed when you can report +90785 with these above mentioned codes. Also, note that whenever you are reporting +90785, it should be accompanied with proper documentation to support the need for reporting this add-on code with the other primary codes that you are reporting.