CPT Code 90836: Understanding Psychotherapy Codes
Introduction
Psychotherapy involves a range of techniques to address emotional, behavioral, and cognitive concerns. Accurate coding for psychotherapy services is crucial for proper billing and reimbursement. This guide explores the details of psychotherapy codes, specifically focusing on the +90836 CPT code.
Understanding Psychotherapy Code Sets
Psychotherapy codes are divided into two primary sets:
Primary Psychotherapy Codes
These codes represent the time spent providing psychotherapy services. They include:
- 90832: Individual psychotherapy, insight-oriented, behavior modifying, and/or supportive, 30 minutes with the patient and/or family member (time range 16-37 minutes)
- 90834: Individual psychotherapy, insight-oriented, behavior modifying, and/or supportive, 45 minutes with the patient and/or family member (time range 38-52 minutes)
- 90837: Individual psychotherapy, insight-oriented, behavior modifying, and/or supportive, 60 minutes with the patient and/or family member (time range at least 53 minutes)
Add-on Psychotherapy Codes
These codes are used when psychotherapy is provided in conjunction with an evaluation and management (E/M) service. They include:
- +90833: Add-on code for individual psychotherapy, insight-oriented, behavior modifying, and/or supportive, 30 minutes with the patient and/or family member (time range 16-37 minutes)
- +90836: Add-on code for individual psychotherapy, insight-oriented, behavior modifying, and/or supportive, 45 minutes with the patient and/or family member (time range 38-52 minutes)
- +90838: Add-on code for individual psychotherapy, insight-oriented, behavior modifying, and/or supportive, 60 minutes with the patient and/or family member (time range at least 53 minutes)
+90836 CPT Code Description
The +90836 CPT code is an add-on code used for individual psychotherapy, insight-oriented, behavior modifying, and/or supportive, provided for 45 minutes with the patient and/or family member (time range 38-52 minutes). This code is specifically used when psychotherapy is performed in conjunction with an E/M service.
Documentation Requirements for CPT Code 90836
In order to bill for CPT Code 90836, the mental health professional must document the following information in the patient’s medical record:
- The date and time of the psychotherapy session.
- The duration of the psychotherapy session.
- The type of psychotherapy provided.
- The patient’s presenting problem.
- The patient’s progress in treatment.
Reimbursement for CPT Code 90836
The reimbursement rate for CPT Code 90836 varies depending on the type of insurance, the provider’s location, and the provider’s qualifications. Mental health professionals should check with their insurance carriers to determine the specific reimbursement rate for this code.
Accurate Coding Principles for Psychotherapy Services
To ensure accurate coding of psychotherapy services, adhere to the following principles:
Time-based Coding
Choose the CPT code that most closely aligns with the actual time spent providing psychotherapy services. Round down to the nearest 15 minutes.
Patient Presence
The patient must be present for all or some portion of the psychotherapy service.
Interactive Complexity
If a patient cannot communicate by any means, do not bill for interactive complexity codes.
Conjunction with E/M Services
When psychotherapy is performed in conjunction with an E/M service, use add-on psychotherapy codes (+90833, +90836, +90838) to indicate both services were provided.
Billing Examples for Psychotherapy Services
To illustrate the application of CPT codes for individual psychotherapy, consider these examples:
- Scenario 1: A psychiatrist provides 40 minutes of individual psychotherapy to a patient during the same encounter as an E/M service. The appropriate codes are 99212 (E/M service) and +90836 (add-on psychotherapy code for 45 minutes).
- Scenario 2: A psychologist provides 55 minutes of individual psychotherapy to a patient. The appropriate code is 90837 (individual psychotherapy code for 60 minutes).
Coding Considerations for Solo Practitioners
Solo practitioners who provide both E/M and psychotherapy services to patients on a weekly basis can independently code and document each service based on the patient’s presenting problem and the duration of psychotherapy provided.
Fee Distribution
When submitting invoices for psychotherapy services, some insurers may require the distribution of the total fee between the E/M and psychotherapy codes. A reasonable approach is to base the apportionment on the relative value units (RVUs) assigned to each code by Medicare.
To conclude,
Accurate coding of individual psychotherapy services is crucial for healthcare providers to ensure proper reimbursement and maintain comprehensive patient records. By adhering to the outlined coding guidelines and considering the billing examples provided, healthcare professionals can effectively navigate the intricacies of individual psychotherapy coding.
About PrimeCare
PrimeCare, a reliable medical billing company, understands the challenges of psychotherapy coding and can assist you in navigating the complexities of this process. Our team of certified coders possesses in-depth knowledge of the latest CPT guidelines and policies, ensuring that your claims are accurate, compliant, and reimbursed promptly. We can help you identify and apply the appropriate psychotherapy codes for your services, preventing errors and maximizing your revenue. Contact us today to learn more about our psychotherapy billing and coding services.
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