CPT Code Add On FAQ: 2013 Changes for Mental Health Providers

I am in an outpatient, private practice setting. I have some questions:

1)   I am not sure about the use of add-ons [90785].

ANSWER: 90785 (interactive complexity) can only be used as an add on if the following criteria is met:

• · If the clients has another individual legally responsible for their care, such as in the case of: minors, adults with guardians, or the patient makes a Request for others to be involved in their care (such as adults accompanied by one or more  participating family members, or interpreter or language translator), or if the patient/client requires the involvement of other third parties, such as child welfare agencies, parole or probation officers, or schools.

Interactive complexity is commonly present during visits by children and adolescents, but may apply to visits by adults, as well.

Also depending upon the insurance benefits, a prior authorization may be needed to use the add on code 90785.

2)  I have a couple of patients that I routinely see for 90 minutes because they travel a long distance for appointments.  I am not sure how to code these sessions [I used 90808 before].

ANSWER: The replacement code for 90808 (75-80 mins) is 90837 (60 minutes).  Unfortunately, there is no add on code available for additional time for traditional psychotherapy practices.

There is a crisis code, that is 90839 (60 mins) with an add on 90840 (an additional 30 mins). However, it seems this should only be used in extreme cases.

If you are hoping to bill for longer that 60 minutes, my suggestion would be to call the insurance company and explain the situation as to why more therapy time is indicated. Perhaps your client can get pre-authorization for 90837 (60 mins) and maybe 90832 (30 mins) to be billed in the same day.  Good luck!

3) I also am confused about the use of codes 99354-99357.  An explanation of how to use these codes would be greatly appreciated.

ANSWER: I obtained this (below) via CMS website.  This is to be used only for actual physicians, not mental health providers.  It looks like this is to be used with patient appointments that are longer then the usual allotted time. It is likely these codes will not be reimbursed for services provider by mental health providers.

99354	PROLONGED PHYSICIAN SERVICE IN THE OFFICE OR OTHER OUTPATIENT SETTING REQUIRING DIRECT (FACE-TO-FACE) PATIENT CONTACT BEYOND THE USUAL SERVICE; FIRST HOUR (LIST SEPARATELY IN ADDITION TO CODE FOR OFFICE OR OTHER OUTPATIENT EVALUATION AND MANAGEMENT SERVICE)
99355	PROLONGED PHYSICIAN SERVICE IN THE OFFICE OR OTHER OUTPATIENT SETTING REQUIRING DIRECT (FACE-TO-FACE) PATIENT CONTACT BEYOND THE USUAL SERVICE; EACH ADDITIONAL 30 MINUTES (LIST SEPARATELY IN ADDITION TO CODE FOR PROLONGED PHYSICIAN SERVICE)
99356	PROLONGED PHYSICIAN SERVICE IN THE INPATIENT SETTING, REQUIRING UNIT/FLOOR TIME BEYOND THE USUAL SERVICE; FIRST HOUR (LIST SEPARATELY IN ADDITION TO CODE FOR INPATIENT EVALUATION AND MANAGEMENT SERVICE)
99357	PROLONGED PHYSICIAN SERVICE IN THE INPATIENT SETTING, REQUIRING UNIT/FLOOR TIME BEYOND THE USUAL SERVICE; EACH ADDITIONAL 30 MINUTES (LIST SEPARATELY IN ADDITION TO CODE FOR PROLONGED PHYSICIAN SERVICE)

 

4)  What codes are used for internet or teletherapy?

ANSWER: There appears to not really be a CPT code for telephone sessions.  Most insurance companies will not cover this.  This is information that I found below.

The new issue of the *Psychiatric News* (vol. 44, #22) Includes a Q & A

from the American Psychiatric Association’s HelpLine Database on how to
bill for phone therapy.

Key points are:

1. There is no CPT code for conducting psychotherapy over the telephone.
2. All the psychotherapy codes are described as face to face with the patient.
3. The only appropriate code to use would be 90899, “unlisted psychiatric
   service or procedure.”

If you use this code, you should provide documentation describing that
it is for psychotherapy over the telephone. This could could also be used for other unlisted psychiatric services or procedures, e.g. outcomes assessment using a standard instrument.

There are timed codes for E/M services provided on the telephone (99441:5-10 minutes; 99442: 11-20 minutes; 99443: 21-30 minutes). These codes can be used for medical discussion with a patient for whom you have not provided an E/M service within the past seven days and whom you would not be seeing for the reason discussed in the call.

The CPT code for online therapy is 0074-T, and is generally not reimbursed or accepted by insurance companies.

4. After much research I cannot seem to figure out how to utilize the add-on code 90785.

This new code exactly describes the Program I run for Toddler’s with Autism; I see that the reimbursement is listed (AMA) at 3.95.

So, what in the world does that mean? I know it is used in addition to the main code, but how do we list the time attached to it?

ANSWER: From my research of the code 90785, there really does not seem to be much effect on reimbursements.  It is created mostly to show was done during the therapy session, not to increase compensation much.  I found the reimbursement rates to be about $3.00 – $4.00 extra per appointment. However, it can be billed as follows: insert the add on code into the second line of the claim. The code can only be billed as one unit.

For example: First line of the 1500 form, input the CPT code 90832. On the second line of the 1500 form, input 90785 for the same date of service.  That code is not to be used as time added to the session.  It is used to show the complexity of the session.

5. Are there new Play Therapy CPT code add ons?

ANSWER: We could not find anything new related to play therapy CPT or add on codes.

6. Are there any 2013 CPT codes for psychotherapy sessions conducted over the phone that are provided by a counselor who is NOT eligible to conduct “evaluation & management”?

ANSWER: No, telephone psychotherapy is not really a recognized code and most insurances will not cover it. CPT 90899 is “unlisted psychotherapy session” but I do not think that I would recommend using that code for telephone sessions.

7. Since there is no longer a CPT code for a 75-80 minute psychotherapy session (90808)

, it appears that unless a session qualifies as either a crisis (90839 + 90840) or involves interactive complexity (90837 + 90785), counselors are only able to use the new code of 90837 (53+ minutes).  Is this correct or is a counselor able to use some other code to account for the additional time spent with the client? For example, can a counselor bill insurance using (90837 + 90832) or (90837 + some other 30 minute code)? There are no add on coded for 90837 except for 90785.  You can not bill 90837 + 90832 .  

ANSWER: Unfortunately, time is being limited in sessions with this new cpt codes.  It should be ok for the patient to be seen 2x a week at 90837 (if their insurance allows).

8. Would a counselor be able to use code 90839 + 90840 if working with a client who is in high distress under complex circumstances and who needs to be seen once a week for 90 minutes?  I’m not sure that I would say the client requires urgent or immediate care, but they definitely need to be seen once a week.

ANSWER: This is unlikely to work as you are describing, as the code is for crisis/urgent treatment.  Please see below:

• New “crisis” codes have been created for urgent treatment. CPT 90839 for an initial 60 minute session and an add-on code CPT +90840 for additional 30 minutes increments (which do not have to be contiguous with CPT 90839 time of service). Service elements include assessment, history, mental status exam, psychotherapy, mobilization of service resources, implementation of interventions to minimize trauma and final disposition. These codes are not to be billed with CPT 90791 or 90792 or the primary psychotherapy code set.

 

9. This may be a silly question, but one of the criteria that qualifies a session to be coded with the add-on CPT code 90785  is that there is “evidence or disclosure of a sentinel event and mandated report to a third party”.

  Is it correct to assume that if a counselor is working with an individual adult client who was sexually abused prior to the age of 18, and the abuse is the main focus of the therapy, that the abuse would NOT be considered a sentinel event because mandatory reporting is no longer required given the client’s present adult age?  

ANSWER: In that situation, the 90785 add on code should not be used.

We hope this helps! For more help, please feel free to contact Thriveworks Mental Health Billing at 1-855-664-5154.

Dr. Anthony Centore is CEO of Thriveworks is Private Practice Consultant for the American Counseling Association, and Author of “How to Thrive In Counseling Private Practice.” Learn more at https://twx.atlantacounseling.com/counseling-private-practice-book/

 

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