Billing and Coding: Psychiatric Diagnostic Evaluation and Psychotherapy
Services

This Billing and Coding Article provides billing and coding guidance for Local
Coverage Determination (LCD) L33252 Psychiatric Diagnostic Evaluation and
Psychotherapy Services. Please refer to the LCD for reasonable and necessary
requirements.  
  
**Coding Guidance**

**Notice:** It is not appropriate to bill Medicare for services that are not
covered (as described by the entire LCD) as if they are covered. When billing
for non-covered services, use the appropriate modifier.  
  
The psychotherapy for crisis CPT codes 90839 and 90840 are time-based codes
used to report the total duration of time face-to-face with the patient and/or
family spent by the physician or other qualified health care professional
providing psychotherapy for crisis, even if the time spent on that date is not
continuous. For any given period of time spent providing psychotherapy for
crisis state, the physician or other qualified health care professional must
devote his or her full attention to the patient and, therefore, cannot provide
service to any other patient during the same time period. The patient must be
present for all or some of the service. Do not report with CPT codes 90791 or
90792.  
  
When a patient is referred with an organic diagnosis and a mental health
diagnosis is established, the mental health diagnosis should be billed.  
  
If a psychiatric diagnostic evaluation with medical assessment is performed,
the physician or non-physician practitioner (NPP) may use CPT code 90792 or an
evaluation and management (E/M) code.  
  
If a patient is unable to communicate by any means, the interactive complexity
CPT code 90785 should not be billed. This service is used in conjunction with
codes for diagnostic psychiatric evaluation (CPT codes 90791, 90792),
psychotherapy (CPT codes 90832, 90834, 90837), psychotherapy when performed
with an E/M service (CPT codes 90833, 90836, 90838, 99202-99255, 99304-99310,
99341-99350), and group psychotherapy (CPT code 90853). When billed in
conjunction with time-based codes, the documentation must indicate the amount
of time spent in providing interactive complexity services.  
  
Psychotherapy services (CPT codes 90832-90838) are time-based codes. Start and
stop times or total times must be documented for CPT codes 90832, 90834, and
90837. For psychotherapy services performed with an E/M service (CPT codes
90833, 90836, and 90838), it is recognized that the psychotherapy time may not
be continuous in a combined psychotherapy with an E/M service. However, since
psychotherapy is a time-based code, the expectation would be documentation of
the start and stop times or total time of the psychotherapy with an E/M
service and documentation of the start and stop times or total time devoted to
psychotherapy. The total time does not include the E/M time. Also note that
when psychotherapy is performed with an E/M by the same physician or NPP, the
documentation should show that they are separately identifiable services.
Psychotherapy times are for face-to-face services with the patient. The
patient must be present for all or some of the service. In reporting, choose
the code closest to the actual time (i.e., 16-37 minutes for CPT codes 90832
and 90833, 38-52 minutes for CPT codes 90834 and 90836, and 53 or more minutes
for CPT codes 90837 and 90838). Do not report psychotherapy of less than 16
minutes duration.  
  
Prolonged services may not be reported when psychotherapy services billed with
an E/M service (i.e., add-on CPT codes 90833, 90836, 90838) are reported. For
CPT code 90837 (psychotherapy, 60 minutes with patient), a physician or other
qualified health care professional can report a prolonged service code if the
psychotherapy service, not performed with an E/M service, is 90 minutes or
longer involving direct patient contact.  
  
The psychoanalysis CPT code 90845 is not time-related, but the service is
usually 45 to 50 minutes in duration. The code may be billed once for each
daily session regardless of the time involved.

**Documentation Requirements**

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed. 
  4. When the documentation of time is relevant for coding and payment purposes, time may be documented with start and stop times or with total time.