Wiki CPT 90833 documentation

[KSLmom]

I have a question regarding the documentation of 90833. Does the documentation have to specifically mention individual vs group psychotherapy? Our current documentation shows the following:
16 minutes spent in therapy. Type of therapy: supportive psychotherapy. Targeted symptoms are recorded. Goals of therapy are mentioned. Progress of therapy and specific points covered in therapy are mentioned.
Is this enough to code for the 90833?
**edit** - This is combined with 99214, but I am questioning just the therapy portion.
Thank you!

 

[CBLENNIE]

90833 is in the CPT code range for individual psychotherapy services and it is an add-on code for E&M services rendered to the patient on the same day with the same practitioner. Here is a snip of the CPT section guidelines regarding code range 90832-90838.


So, to answer your question, no you shouldn't have to specifically state that the session is individual vs. group since the code is specifically for individual psychotherapy services and the clinical documentation should support that the services were for individual psychotherapy.

Also, you need to make sure the documentation for the time spent on the individual psychotherapy is separate from the time the provider spent on the E&M service that is the primary code for billing 90833. If the patient did not receive E&M services on the same day from the same practitioner, then you need to look at 90832, which represents the same amount of time for the individual psychotherapy visit but it is a stand-alone code. Your posting indicates what the current documentation is for your use of 90833 but nothing indicates that the E&M service happened that is required to bill 90833.

I don't know if this was intentionally left out of your post, or if the E&M services are not being rendered to the patient by the same practitioner on the same DOS as the 90833 but if the patient is not receiving the E&M services you need to revisit your code selection for the individual psychotherapy services. If you are receiving reimbursement currently for billing 90833 without the E&M, eventually the insurance companies are going to realize there is an issue and you'll more than likely start receiving denials for billing an add-on code without the appropriate primary code and you may receive overpayment requests for the claims that were previously paid in error.

 

[KSLmom]

90833 is in the CPT code range for individual psychotherapy services and it is an add-on code for E&M services rendered to the patient on the same day with the same practitioner. Here is a snip of the CPT section guidelines regarding code range 90832-90838.
View attachment 6676
View attachment 6677
So, to answer your question, no you shouldn't have to specifically state that the session is individual vs. group since the code is specifically for individual psychotherapy services and the clinical documentation should support that the services were for individual psychotherapy.

Also, you need to make sure the documentation for the time spent on the individual psychotherapy is separate from the time the provider spent on the E&M service that is the primary code for billing 90833. If the patient did not receive E&M services on the same day from the same practitioner, then you need to look at 90832, which represents the same amount of time for the individual psychotherapy visit but it is a stand-alone code. Your posting indicates what the current documentation is for your use of 90833 but nothing indicates that the E&M service happened that is required to bill 90833.

I don't know if this was intentionally left out of your post, or if the E&M services are not being rendered to the patient by the same practitioner on the same DOS as the 90833 but if the patient is not receiving the E&M services you need to revisit your code selection for the individual psychotherapy services. If you are receiving reimbursement currently for billing 90833 without the E&M, eventually the insurance companies are going to realize there is an issue and you'll more than likely start receiving denials for billing an add-on code without the appropriate primary code and you may receive overpayment requests for the claims that were previously paid in error.

Thank you so much! I did leave the E/M portion off because I was really just questioning if documentation supports a 90833. I received a denial stating that it didn't specify individual vs group and it says "supportive therapy." In my opinion coding 90833 was appropriate, but I wanted to double check to make sure. Thank you for all of the information.

 

[CBLENNIE]

I'm assuming the documentation indicated that the patient was present for the session. The documentation for group therapy should indicate the number of participants as well as the reactions of each member (without including any PHI of the various participants in a specific patient's chart) which your example note did not include.

It seems to me that the payer is being persnickety about the note clearly stating that it is individual therapy vs. group, but that is just my opinion and I work for a commercial insurance company. I would never assume that a visit was for group therapy unless the note indicated that it was a group session and the number of participants.

 

[KSLmom]

I'm assuming the documentation indicated that the patient was present for the session. The documentation for group therapy should indicate the number of participants as well as the reactions of each member (without including any PHI of the various participants in a specific patient's chart) which your example note did not include.

It seems to me that the payer is being persnickety about the note clearly stating that it is individual therapy vs. group, but that is just my opinion and I work for a commercial insurance company. I would never assume that a visit was for group therapy unless the note indicated that it was a group session and the number of participants.

Thank you so much!!