Psychiatry Coding & Reimbursement Alert
Planning on EMDR? Check With Your Payer First
Question: We have this new psychiatrist who plans on performing EMDR to patients suffering from PTSD? Is this service covered? If so, what codes do I use to report this therapy? Please do let me know as I am told by some that this service is not covered.
Nebraska Subscriber
Answer: EMDR (Eye movement desensitization and reprocessing) is a type of psychotherapy that is based on the thought that a patient suffers from a psychiatric issue due to disturbing memories. When performing EMDR, your clinician will aim at processing these memories, try to reduce their effects, and help the patient try to overcome them by developing mechanisms to cope with the problem.
When performing EMDR, your clinician will integrate cognitive behavioral, psychodynamic, interpersonal, and body-centered therapies in an eight phase treatment approach to help patients overcome their disturbing thoughts. Since disturbing memories are commonly experienced in patients suffering from post traumatic stress disorder (PTSD), your clinician might often use EMDR in the treatment of patients suffering from this condition.
Coverage for EMDR varies from payer to payer. If your clinician is planning to perform EMDR on patients, it is best to check with the individual payer to know if the service is covered. If the service is covered, it is best to see if the payer requires any additional specialization in performing this particular type of psychotherapy or has other limitations for it to be a covered service. Also, check if the service needs pre-authorization for it to be a covered service.
If the service is covered, you will have to report it using one of the psychotherapy codes in Current Procedural Terminology (CPT®), since there are no other CPT® or Healthcare Common Procedure Coding System codes that specifically describe the service. You will have to report the services of your clinician based on the time that he spends in performing the service, as you would do when reporting any cognitive behavioral psychotherapy session. For example, if he spends 45 minutes on performing the EMDR, you will have to report 90834 (Psychotherapy, 45 minutes with patient and/or family member) to report the service.
Psychiatry Coding & Reimbursement Alert
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