Psychiatry Coding & Reimbursement Alert

Question: Our psychiatrist performs counseling sessions with the patient’s family and in the same session performs psychotherapy. I am planning on reporting 90847 with an appropriate psychotherapy code. Are we allowed to report both the codes for the same patient on the same date of service? If so, should any modifier be appended to either of the codes to allow both the codes to be reported?

Florida Subscriber

Answer: In the scenario, you state you are planning on reporting 90847 (Family psychotherapy [conjoint psychotherapy] [with patient present]) in addition to one of the psychotherapy codes, 90832-90838. Since you are planning on reporting 90847, the descriptor indicates the patient was present during the session that your psychiatrist undertook with the patient’s family.

In such a case, you will have to understand the focus of the session to aptly report the right CPT® code for the session. If, in the session, your clinician focused on counseling the family members and how they could help in improving on the treatment outcome through their understanding, behavior, and interaction with the patient in an everyday setting, then you are right in reporting 90847 for the family psychotherapy part of the session and using an appropriate CPT®code (90832-90838) for the psychotherapy part of the session that is focused on the patient.

The Correct Coding Initiative (CCI) does not list any edit bundles for reporting psychotherapy codes (90832-90838) with family psychotherapy codes, 90846 (Family psychotherapy [without the patient present]) and 90847. Therefore, you can report the two codes separately on the same claim form without using any modifiers with either of the codes.

However, if the objective of the family session was also focused on the patient with some small degree of involvement of family members, you should not report this part of the session separately with 90847 (or 90846). The time for each psychotherapy code is now described as time spent with the patient and/or family member. This description allows for the participation of others in the psychotherapy session for the patient as long as the patient remains the focus of the intervention.Since you should use psychotherapy codes for psychotherapy sessions involving family members also, you can just add up the time spent on the session with the family present and with only the patient present. Then, you should report one appropriate psychotherapy code from the CPT® code range 90832-90838 based on the total time spent.

For example, if your clinician spent 15 minutes on the family session and 30 minutes for the psychotherapy session with the patient and the focus was on the patient throughout, you sum the time and report 90834 (Psychotherapy, 45 minutes with patient and/or family member). You’ll use this code for a psychotherapy session that lasts 45 minutes.