Psychiatry Coding & Reimbursement Alert

Question: I am new to psychiatry coding. Our psychiatrist routinely performs medication management with psychotherapy sessions for his patients. I know that you have to report medication management with E/M codes and the psychotherapy with add-on codes. But, will the level of E/M have any influence on the psychotherapy codes that I am reporting?

Florida Subscriber

Answer: Even though you report psychotherapy codes, +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 (…45 minutes…) and +90838 (…60 minutes…) as add-on codes to an E/M code, the level of E/M code that you are reporting has no bearing on the add-on psychotherapy code. Your choice of the add-on psychotherapy code is solely dependent on the time that your clinician spent performing the psychotherapy session.

Note: Don’t add time spent in performing the E/M service into the time spent performing the psychotherapy to calculate time. Although psychotherapy codes have specific time descriptors, you report these services on a range of time. So, you report +90833 for a session lasting 16 to 37 minutes, +90836 for 38 to 52 minutes and report +90838 for sessions lasting more than 53 minutes. Do not report psychotherapy of less than 16 minutes duration.

Also note that when reporting a psychotherapy add-on code, such as +90833, in addition to an E/M service, CPT^® advises not to use time as the basis of E/M code selection. Instead, you should rely on history, exam, and medical decision making when choosing the level of E/M code.