Psychotherapy Codes Major Changes for 2013 ©2013 National Association of Social Workers. All Rights Reserved. 1 © CPT copyright 2012. American Medical

Psychotherapy CodesMajor Changes for 2013

©2013 National Association of Social Workers. All Rights Reserved. 1

© CPT copyright 2012. American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Mirean Coleman, LICSW, CT

Purpose

•To provide an overview of the new psychotherapy codes which became effective January 1, 2013•To make clinical social workers aware of psychotherapy codes available for use by them•To help clinical social workers become HIPAA compliant with electronic code transactions in 2013


Revision Process

• The psychotherapy codes were last revised in 1998

• NASW was involved in the revision process• CPT Editorial Panel developed a work group• Work group consisted of the Academy of Child

and Adolescent Psychiatry, American Nurses Association, American Psychiatric Association, American Psychological Association, and NASW


Why Change the Codes

Since 1998, mental health services changed

(1) Reduction in inpatient beds, creating large

volume of outpatient mental health services

(2) Work intensified in outpatient services

(3) Co-morbid conditions increased


Deleted Codes

90801: Psychiatric Diagnostic Interview

90802: Interactive Psychiatric Diagnostic Interview

90804, 90806, 90808: Individual Outpatient Psychotherapy

90810, 90812, 90814: Interactive Individual Outpatient Psychotherapy


Deleted Codes

90816, 90818, 90821: Residential Individual Outpatient Psychotherapy

90823, 90826, 90828: Interactive Individual Outpatient Psychotherapy

90857: Interactive Group Psychotherapy


Codes Without Changes

90845: Psychoanalysis

90846: Family Psychotherapy (without the patient present)

90847: Family psychotherapy (conjoint psychotherapy, with the patient present)

90849: Multiple-family group psychotherapy


Codes Without Changes

90853: Group psychotherapy (other than of a multiple-family group)

90880: Hypnotherapy

90889: Preparation of report of patient’s psychiatric status, history, treatment or progress (other than for legal or consultative purposes) for other physicians, agencies, or insurance carriers.


Family of Codes Without Changes

• Health and Behavior Assessment and Intervention Codes were not changed

• These codes identify services focusing on bio-psychosocial factors affecting physical health problems



96150: Health and behavior assessment

96151: Reassessment

96152: Health and behavior intervention, individual

96153: Group (2 or more patients)

96154: Family (with the patient present)

96155: Family (without the patient present)



Medical Team Conference Codes

(1) Face-to-face participation by three or more

licensed health care providers from

different health care specialties.

(2) Participants are actively involved in the

development and coordination of health

care services.



99366: Medical team conference with interdisciplinary team of health care professionals, face-to-face with patient and/or family, 30 minutes or more……….

99368: Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more…….


New Codes

• Several new codes were developed• Individual psychotherapy codes were deleted• Services are for face-to-face services only• All settings are included• Evaluation and Management component was

separated in the diagnostic interview


New Codes

90791: Psychiatric Diagnostic Interview

An integrated, bio-psychosocial

assessment, including history, mental

status, and recommendations


Coding Tips for 90791

• Can only be reported once a day• Can be used more than once if needed• Are only for the patient, and not the informant• Does not include psychotherapeutic services


Other New Code

• 90832: Psychotherapy, 30 minutes with patient and/or family member.

The time range for this code is 16 to 37 minutes.


• 90834: Psychotherapy 45 minutes with patient and/or family member

The time range for this code is 38 to 52 minutes.


New Code

• 90837: Psychotherapy 60 minutes with patient and/or family member

The time range for this code is 53 minutes or more.

New Code


Time Factor Recommendation

Follow the time specified in the code descriptor in order to avoid possible overpayment requests especially when an insurance company requests documentation of the start and stop times of the psychotherapy session.


Time Coding Tip

When patient is seen beyond 90837, 60 minutes, then a prolonged service code can be used if patient is seen for a minimum of 90 minutes.


Prolonged Service Codes

Prolonged Service Codes include

•99354 Prolonged Service With Direct Patient

contact

Check with your insurance company to see if they will allow you to use this code.


Coding Tips for 90832, 90834, 90837

• The psychotherapy session identified in these codes is primarily with the patient, not the family

• The family is used to obtain information • Psychotherapy concerned with the effects of the

patient’s condition on the individual being interviewed is not reimbursable as part of the clinical social worker’s services to the patient.


Coding Tips for 90791,90832, 90834, 90837

• When using these codes, the patient should be the primary receiver of psychotherapy services

• Clearly document this in the patient’s record to avoid overpayment requests


Interactive Complexity

• 90785 is an add-on code for interactive complexity

• Report with 90791, 90832, 90834, 90837, and 90853

• Refers to communication factors that complicate the delivery of psychiatric procedures.



Common factors include:(1) More difficult communication with discordant or

emotional family members

(2) Engagement of young and verbally undeveloped

or impaired patients



Typical patients are:

1. Third-parties such as parents, guardians, and other family members

2. Interpreters, language translators

3. Agencies

4. Court officers

5. Schools involved in their psychiatric care



Factors present with patients who:

(1) Have other individuals legally responsible for their care

(2) Request others to be involved in their care

during the visit

(3) Require the involvement of other third

parties



Interactive complexity procedures may be reported when one of the following is present:

(1) The need to manage maladaptive communication among participants complicates delivery of care.

(2) Caregiver emotions or behavior that interferes

with the caregiver’s understanding and ability

to assist with the treatment plan


Interactive Complexity(3) Evidence or disclosure of a sentinel event and

mandated report to third-party with the initiation of

discussion of the sentinel event and/or report with

patient and other interview participants

(4) Use of play equipment, other physical devices,

interpreter, or translator to communicate with the

patient to overcome barriers to the therapeutic or

diagnostic process



Use with a patient who

(1) Is not fluent in the same language as the clinical social worker

(2) Has not developed, or has lost, either the

expressive language communication skills to

explain his/her symptoms and response to

treatment


Psychotherapy for Crisis

• A new service identified through coding

• An urgent assessment and history of a crisis state, a mental status exam, and a disposition.

• Presenting problem is life threatening or complex and requires immediate attention



Treatment includes

(1) Psychotherapy

(2) Mobilization of resources to defuse the crisis

and restore safety

(3)Implementation of psychotherapeutic

interventions to minimize potential psychological

trauma



• 90839 Psychotherapy for crisis, first 60 minutes

• 90840 Each additional 60 minutes

This is an add-on code. List separately in addition to 90839


Coding Tips for 90839 and 90840

• Must devote your full attention to the patient• Cannot provide services to another patient during

the same time period• Patient must be present for all or some of the

service• Report total face-to-face time with patient and

family even if the time is not continuous• Can only report once a day©2013 National Association of Social Workers. All Rights Reserved. 34

Time Factors for 90839 and 90840

• 90839: Psychotherapy, 60 minutes

30 to 74 minutes. Cannot use this code

if service is less than 30 minutes.

Instead, use 90832• 90840: Can only add on to 90839 if crisis is

beyond the first 74 minutes.


Payment for New Codes

• CMS assigned interim values to the new codes• This was done because the survey process of the

psychotherapy codes is incomplete• We may not know until 2014 what the permanent

rates will be• The interim values set by Medicare has impacted

the rates set by other insurers


Payment for Codes

• Codes to be surveyed are:(1) 90839 Psychotherapy for crisis: carrier-priced

(2) 90840 Psychotherapy for crisis: carrier-priced

(3) 90785 Interactive Complexity: carrier-priced


Advocacy for Codes

NASW continues to advocate for clinical social workers in the coding process

Will participate in the survey process in February 2013 to

determine work and practice expense values for 90839,

90840 and 90785

Clinical social workers are encouraged to participate


Questions and Answers Additional questions can be answered at “An Hour With Psychotherapy Codes: Questions and Answers.” It will be held on Wednesdays beginning January 23, 2013 through April 24, 2013 from 12:00 pm to 1:00 pm EST. There is no fee for this teleconference which is opened to NASW members. Name: Psychotherapy CodesTeleconference Number: 866-454-4206Participate Passcode: 488595


January 22, 2013 - ADDENDUM

• Since the Webinar presentations, New Psychotherapy Codes: Major Changes for 2013, on January 11 and 17, the Centers for Medicare and Medicaid Services informed the CPT Editorial Panel they will not reimburse non-physician Medicare providers for the use of the prolonged service code, 99354, with 90837. Clinical social workers should speak with each insurance company in which they are a provider to determine how they may be reimbursed for services which extend beyond the time frame for 90837, especially since 90808 has been deleted. NASW is working with the American Medical Association, the Centers for Medicare and Medicaid Services, and other mental health organizations to rectify this problem. Members will be updated on future coding information as it becomes available.


Documents

Psychotherapy Codes Major Changes for 2013 ©2013 National Association of Social Workers. All Rights Reserved. 1 © CPT copyright 2012. American Medical