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CPT Code Changes for Mental Health Part 2

Visit our CPT Code Guide for up to date information on the 2013 CPT Code changes.

While the CPT code changes are rather replete, it is relatively straightforward to understand.  The bigger challenge will be for prescribers who are unfamiliar with E&M coding to become fluent.  As of Jan 1 2013, all medical management, including medication management will only be compensated when documented via E&M codes.  The general shift is to define therapy services as added procedures similar to how other procedures are defined in the CPT codebook.

The four major revisions are new patient codes are divided between two codes to define therapy intake or medical management intake.  Secondly therapy services are divided into three timeframes and follow standard E&M guidelines for time.  Third, interactive documentation is an add-on and it now has broader definition.  Lastly, there is a crisis code intended as a crisis psychotherapy.

90801 and 90802 are being replaced by 90791 and 90792.  90791 is treated no differently than 90801.  When evaluation and management are involved in the assessment, typically 90792 is billed.  If there is any interactive complexity, 90785 is billed along with the intake code.  See below for more information on billing with interactive code 90785.

Therapy codes 90804, 90807, 90809, 90816, 90818, 90821, 90810, 90823, 90812, 90826, 90814, 90828 are all deleted.  Therapy is no longer coded by site.  There are also not separate codes for interactive visits.  Therapy is either coded as the primary service or if added to an E&M service.  Interactive is added in the same way as the new patient visits.    Therapy codes when not part of E&M are 90832, 90834 and 90837.

90832 is a 30-minute psychotherapy visit.  Following time guidelines for other CPT coding, the code is used when half the time is met and up to half-way to the next appropriate code.  This would be 16-37 minutes.

90834 is a 45-minute psychotherapy visit.  In similar fashion, it is billed for visits lasting between 38 and 52 minutes.

90837 is a 60-minute psychotherapy visit.  It is billed for visits lasting 53 minutes or more.

Psychiatrists, Nurse Practitioners (Specialists), PAs, and Psychologists providing medical management should bill E&M codes when providing services.  When they are also providing therapy, therapy is billed as an add-on code by time.  When billing psychotherapy on top of E&M coding, each much stand independently on their own merits.  E&M codes are billed according to time (when the majority of time is spent on health counseling) or on features of history, physical and medical decision making.  E&M codes should be billed according to the latter and therapy codes must meet specified time.  For further information on E&M, see section on E&M coding.

Codes 90805, 90817, 90810, 90818, 90808, 90821, 90811, 90824, 90813, 90827, 90815, and 90829 are no longer used.  Providers now bill the appropriate E&M code followed by a therapy add-on code.

90833 is a 30-minute psychotherapy visit that mirrors 90832.

90836 is a 45-minute psychotherapy visit that parallels 90834.

90838 is a 60-minute psychotherapy visit like 90837.

Family therapy and group psychotherapy codes are retained.  Interactive group psychotherapy is removed in lieu of the option to add-on an interactive code.

A word on counseling and psychotherapy

In the standard terminology for E&M, the codes are defined based on either time spent or key components of history, physical and medical decision making.  When the code is billed based on time spent, it is defined as half or more of the typical time is spent on counseling.  Counseling defined here is not synonymous with psychotherapy.  Counseling is defined as time spent discussing health and wellness, reviewing with the patient labs and other studies or educating them on medications.  This is different from psychotherapy which involves evaluating and interpreting cognitive and emotional processes that shape thought, coping, outlook and interpersonal relationships, among other things.

*CPT five-digit codes are copyright of the American Medical Association

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