Psychiatry Coding & Reimbursement Alert

Question: Our teaching psychiatrist supervises services provided by residents. If the resident is performing a time based procedure like psychotherapy, should the entire time spent by the resident with the patient be used to calculate the time or only the time when our psychiatrist is present supervising the resident?

Connecticut Subscriber

Answer: When reporting time based services like psychotherapy, you should calculate time only when your psychiatrist is present supervising the resident performing the service, according to section 100.1.4 of chapter 12 of the Medicare Claims Processing Manual. You should not add any additional time that the resident spends with the patient alone.

For instance, if your psychiatrist is present with the resident while providing the psychotherapy service for a duration of 30 minutes and only your resident is present with the patient for another 15 minutes, you will have to report 90832 (Psychotherapy, 30 minutes with patient and/or family member) for the service provided. You do not take into account the additional 15 minutes that your resident spends with the patient in the absence of your psychiatrist and report 90834 (…45 minutes…) for the service provided.

Note: For certain psychiatric services, the requirement for the presence of the teaching physician during the service may be met by concurrent observation of the service by use of a one-way mirror or video equipment. Audio-only equipment does not satisfy to the physical presence requirement, according to section 100.1.3 of chapter 12 of the Medicare Claims Processing Manual.