5 Services Psychiatrists Forget to Bill For

Betsy Nicoletti, MS

Disclosures

January 15, 2019

In This Article

Differentiate Individual and Family Therapy

The CPT code for family psychotherapy is 90847 (with the patient present, 50 minutes) and is an active code in the Medicare Physician Fee Schedule. For family therapy, document who was present during the session, the interactions, and the nature of the psychotherapy. In 2017, CPT added a time of 50 minutes to the description of family therapy.

Prior versions of CPT defined individual psychotherapy as time spent with the patient and/or family member, but the words "and/or family member" were deleted from the description of individual psychotherapy.

Family therapy is used when the clinician focuses on family dynamics and uses family psychotherapy techniques. In that case, report code 90487 and document the time of the therapy session. Because the code is defined as 50 minutes, over 25 minutes must be spent in order to bill the code. Sometimes, family members are present in an individual therapy session, but the focus of this therapy is on the individual. In that case, bill the individual psychotherapy codes.

Remember the Add-on Code for Interactive Complexity

There is also an add-on code with a very small payment for interactive complexity. Code 90785 may be added to the diagnostic psychiatric evaluation (90791, 90792), to psychotherapy services (90833–90838), and to group psychotherapy (90853).

There are specific requirements for using this code. It refers to communication factors that complicate providing psychiatric services.

The CPT book defines it this way: "Common factors include more difficult communication with discordant or emotional family members and engagement of young and verbally undeveloped or impaired patients. Typical patients are those who have third parties, such as parents, guardians, other family members, interpreters, language translators, agencies, court officers, or schools involved in their psychiatric care."

One of these factors is typically present according to the CPT book:

  • A patient who has another individual legally responsible for their care

  • A patient who requests that others, such as a family member or interpreter, be involved during the visit

  • A patient who requires the involvement of a third party, such as a child welfare agency or parole or probation officer

In addition, one of the following must be present in order to report interactive complexity:

  • The need for management of maladaptive communication

  • Caregiver emotions or behavior interfering with treatment

  • Evidence for disclosure of a sentinel event with mandated reporting to a third party

  • Use of play equipment

  • Patient with limited language proficiency

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