Billing and Coding: Psychiatry and Psychology Services

The billing and coding information in this article is dependent on the
coverage indications, limitations and/or medical necessity described in the
associated LCD L34616 Psychiatry and Psychology Services.

**General Coding**  
Psychiatry and Psychology are specialized fields for the diagnosis and
treatment of various mental health disorders and/or diseases. References to
providers include physicians and non-physicians, such as clinical
psychologists, independent psychologists, nurse practitioners, clinical nurse
specialists and physician assistances when the services performed are within
the scope of their state license and clinical practice/education.

Individual psychotherapy CPT codes should be used only when the focus of
treatment involves individual psychotherapy. Psychiatric service CPT codes
should not be used when other CPT codes such as an evaluation and management
(E/M) service or pharmacological codes is more appropriate.

Interactive Complexity (90785) is an add-on code specific for psychiatric
services and refers to communication difficulties during the psychiatric
procedure. Add-on codes may only be reported in conjunction with other codes,
never alone.

The specific communication difficulties are present with patients who
typically:

  1. Have other individuals legally responsible for their care, such as minors or adults with guardians, or
  2. Request others to be involved in their care during the visit, such as adults accompanied by one or more participating family members or interpreter or language translator, or
  3. Require the involvement of other third parties, such as child welfare agencies, parole or probation officers, or schools.

Interactive complexity may be reported with psychiatric procedures when at
least one of the following communication difficulties is present:

  1. The need to manage maladaptive communication (related to, e.g., high anxiety, high reactivity, repeated questions, or disagreement) among participants that complicates delivery of care.
  2. Caregiver emotions/behavior that interfere with implementation of the   
treatment plan.

  3. Evidence/disclosure of a sentinel event and mandated report to a third party (e.g., abuse or neglect with report to state agency) with initiation of discussion of the sentinel event and/or report with patient and other visit participants.
  4. Use of play equipment, physical devices, interpreter, or translator to overcome significant language barriers.

Do not report the CPT add-on code for Interactive Complexity code in
conjunction with Psychotherapy for crisis codes or in conjunction with E/M
services when no psychotherapy service is also reported.

**II. Service-specific Guidelines:**

  1. Psychiatric Diagnostic Interview Examination (90791, 90792).  
A psychiatric diagnostic evaluation or a psychiatric diagnostic evaluation
with medical services can be conducted once, at the onset of an illness or
suspected illness. The same provider may repeat it for the same patient if an
extended break in treatment occurs, if the patient requires admission to an
inpatient status for a psychiatric illness, or for a significant change in
mental status requiring further assessment. This contractor considers an
extended break as approximately 6 months from the last time the patient was
seen or treated for their psychiatric condition. A psychiatric diagnostic
evaluation may also be utilized again if the patient has a previously
established neurological disorder or dementia and there has been an acute
and/or marked mental status change, or a second opinion or diagnostic
clarification is necessary to rule out additional psychiatric or neurological
processes, which may be treatable.

An E/M service may be substituted for the initial interview procedure provided
required elements of the E/M service billed are fulfilled. E/M services
require, in addition to the interview and examination, the provision of a
written opinion and/or advice. E/M CPT codes do not include a psychotherapy
service.

  2. CPT Codes 90832-90838 represent psychotherapy.  
Psychotherapy without medical evaluation and management services are reported
as 90832, 90834 and 90837. Psychotherapy with medical evaluation and
management services are reported with codes for E/M services plus a
psychotherapy add-on code (90833; 90836; 90838). For psychotherapy sessions
lasting longer than 90 minutes, reimbursement will only be made if the report
is supported by the medical record documenting the face-to-face time spent
with the patient and the medical necessity for the extended time.

  3. CPT Codes 90846 and 90847 represent family psychotherapy services for the treatment of mental disorders. They should not be used when the service performed is taking a family history or E/M counseling services. E/M counseling services should be coded with the appropriate E/M CPT code according to the time involved. Family counseling does not include the supervision of or therapy with professional caretakers or staff.
  4. CPT code 90853 represents group therapy. When medically indicated, the interactive complexity add-on code (+90785) may be billed in conjunction with this code.
  5. CPT Code 90839 is for psychotherapy crisis for the first 60 minutes and code 90840   
is for each additional 30 minutes. These codes are reported by themselves and
may  
not be reported with 90791, 90792, 90832-90838, 90785-90899.

  6. Medicare does not cover biofeedback for the treatment of psychosomatic disorders.

**III. Billing Guidelines**

  1. To report both E/M and psychotherapy, the two services must be significant and separately identifiable.
  2. A separate diagnosis is not required for the reporting of E/M and psychotherapy on the same date of service. 
  3. Site of service is not applicable to psychotherapy. Psychotherapy codes are payable in all settings.

**IV. Other Information**  
CPT codes 90885, 90887, 90889 are considered incidental services and are not
separately payable.