Psychiatry Coding & Reimbursement Alert

Question: One of our psychiatrists does group psychotherapy sessions (90853). My question is can an E/M service code be reported on the same calendar date of service on which the patient undergoes a group psychotherapy session? If so, should a modifier be appended to any of the codes?

New York Subscriber

Answer: Your psychiatrist might often perform medication management for a patient on the same day when another service like an individual psychotherapy session or a group psychotherapy session is scheduled. He might also assess the patient for a change in mental status or assess change in symptoms that the patient has been experiencing.

In such a situation, you can consider reporting an E/M code (such as 99212, Office or other outpatient visit for the evaluation and management of an established patient…) on the same day on which the patient is scheduled for a group psychotherapy session (90853, Group psychotherapy [other than of a multiple-family group]).

However, Correct Coding Initiative (CCI) edits bundle E/M codes into group psychotherapy code 90853 with the modifier indicator ‘1,’ which indicates that you can report the two codes on the same calendar date of service by using a suitable modifier. Since the E/M code is the column 2 code in the coding bundle, you will have to append the modifier to the E/M code you are reporting.

The modifier that you will append to the E/M code that you are reporting is 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service).