•when there is a need to observe and correct, through psychotherapeutic techniques, the patient’s interaction with family members; and/or •where there is a need to assess the conflicts or impediments within the family, and assist, through psychotherapeutic techniques, the family members in the management of the patient. Family psychotherapy must be ordered by a provider as an integral part of an active treatment plan for which it is directly related to the patient’s identified condition/diagnosis. Family psychotherapy must be conducted face to face by physicians (MD/DO), psychologists, or other mental health professionals licensed or authorized by state statutes and considered eligible for reimbursement. Family psychotherapy is considered to be medically reasonable and necessary when the patient has a psychiatric illness and/or is demonstrating emotional or behavioral symptoms sufficient to cause inappropriate behavior or maladaptive functioning. In certain types of medical conditions, such as the unconscious or comatose patient, family psychotherapy would not be medically reasonable or necessary. Also, CPT code 90849 (Multiple family group psychotherapy) would not be considered treatment directly related to the patient’s care and therefore would not be considered medically necessary. A family psychotherapy session generally lasts for at least 45-50 minutes. Section V: Psychoanalysis (CPT Code 90845) Psychoanalysis is a treatment modality that uses psychoanalytic theories as the frame for formulation and understanding of the therapy process. These theories provide a focus on increasing self-understanding and deepening insight into emotional issues and conflicts which underlie presenting emotional difficulties. Typically therapists make use of exploration of unconscious thoughts and feelings which may relate to underlying emotional conflicts, interpretation of defensive processes which obstruct emotional awareness, and consideration of issues related to sense of self-esteem. Psychoanalysis uses a special technique to gain insight into a patient's unconscious motivations and conflicts using the development and resolution of a therapeutic transference to achieve therapeutic effect. It is a different therapeutic modality than psychotherapy. The medical record must document the indications for psychoanalysis, description of the transference, and that psychoanalytic techniques were used. The physician using this technique must be trained and credentialed in its use. Clinical nurse specialists (CNS) and nurse practitioners (NP) are not eligible for payment for psychoanalysis. It is not a
F65.9 Paraphilia, unspecified F66 Other sexual disorders F68.10 Factitious disorder, unspecified F68.11 Factitious disorder with predominantly psychological signs and symptoms F68.12 Factitious disorder with predominantly physical signs and symptoms F68.13 Factitious disorder with combined psychological and physical signs and symptoms F68.8 Other specified disorders of adult personality and behavior F69 Unspecified disorder of adult personality and behavior F70 Mild intellectual disabilities F71 Moderate intellectual disabilities F72 Severe intellectual disabilities F73 Profound intellectual disabilities F80.0 Phonological disorder F80.1 Expressive language disorder F80.2 Mixed receptive-expressive language disorder F80.4 Speech and language development delay due to hearing loss F80.81 Childhood onset fluency disorder F80.82 Social pragmatic communication disorder F80.89 Other developmental disorders of speech and language F80.9 Developmental disorder of speech and language, unspecified F81.0 Specific reading disorder F81.2 Mathematics disorder F81.81 Disorder of written expression F81.89 Other developmental disorders of scholastic skills F81.9 Developmental disorder of scholastic skills, unspecified F82 Specific developmental disorder of motor function F88 Other disorders of psychological development F89 Unspecified disorder of psychological development F90.0 Attention-deficit hyperactivity disorder, predominantly inattentive type F90.1 Attention-deficit hyperactivity disorder, predominantly hyperactive type F90.2 Attention-deficit hyperactivity disorder, combined type F90.8 Attention-deficit hyperactivity disorder, other type F90.9 Attention-deficit hyperactivity disorder, unspecified type F91.0 Conduct disorder confined to family context F91.1 Conduct disorder, childhood-onset type F91.2 Conduct disorder, adolescent-onset type F91.3 Oppositional defiant disorder