Psychiatry Coding & Reimbursement Alert

Question: Our psychiatrist recently performed an extended psychotherapy session for a patient. The session lasted about 100 minutes in length. Someone suggested me that I use the prolonged services code, +99354 along with the psychotherapy code to cover for the extra time spent during the session. Is this correct, because generally, prolonged services codes are only used with E/M codes? No other pharmacological management or E/M service was provided during the visit.

Omaha Subscriber

Answer: Your colleague is right in suggesting that you can use a prolonged service code with a psychotherapy code when the session extends beyond 90 minutes or more. Although psychotherapy codes are no longer location specific, you will have to choose an appropriate prolonged services code depending on the location in which your clinician is providing the psychotherapy to the patient.

So, if your psychiatrist is performing the psychotherapy in his office, you can choose +99354 (Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour [List separately in addition to code for office or other outpatient Evaluation and Management service]) as an add-on code to the psychotherapy code, 90837 (Psychotherapy, 60 minutes with patient and/or family member). If the service occurs in an inpatient setting, you will have to use +99356 (Prolonged service in the inpatient or observation setting, requiring unit/floor time beyond the usual service; first hour [List separately in addition to code for inpatient Evaluation and Management service]).

Even though the descriptor to prolonged services codes mention that these codes are add-on codes for E/M codes, the guidelines for 90837 mention that appropriate prolonged services codes can be used with this psychotherapy code for sessions lasting for a duration of 90 minutes or more face-to-face with the patient.

In a case where the session extends beyond 134 minutes, you can consider using one of the add-on codes, +99355 (Prolonged service in the office or other outpatient setting…each additional 30 minutes [List separately in addition to code for prolonged service]) or +99357 (Prolonged service in the inpatient or observation setting… each additional 30 minutes [List separately in addition to code for prolonged service]), again depending on the location of the service, in addition to +99354 or +99356, respectively.