JEREMY S. MUSHER, MD, DFAPA PRESIDENT AND CEO MUSHER GROUP, LLC MUSHERGROUP.COM APA Advisor, AMA/Specialty Society RVS Update Committee (RUC) APA CPT Alternate.

The opinions referenced are those of the Musher Group, LLC based on their coding experience. They are based on the commonly used codes in Psychiatry, which are not all inclusive. Always check with your local insurance carriers as policies vary by region. The final decision for the coding of a procedure must be made by the physician considering regulations of insurance carriers and any local, state or federal laws that apply to the physician’s practice. The Musher Group, LLC and its representatives disclaim any liability arising from the use of these opinions. Disclaimer

90791 Psychiatric Diagnostic Evaluation 90792 Psychiatric Diagnostic Evaluation with medical services Both include History, Mental Status Exam, Recommendations, Ordering of Diagnostic Studies 90792 additionally includes medical assessment, which may include, as indicated, vital signs, gait and station or muscle strength and tone, etc.; review and ordering of laboratory and other diagnostic studies Copyright ©2012 Musher Group, LLC. All Rights Reserved.5

For Both Codes (90791 and 90792) One or more informants may be seen in lieu of the patient May be reported more than once when separate evaluations are conducted with patient and informant(s) Copyright ©2012 Musher Group, LLC. All Rights Reserved.6

NEW CODE USE FOR PSYCHIATRY: Add On Code: A code that describes the work that is performed in addition to the primary service It is never reported alone Two or more codes billed: Primary and Add On(s) Copyright ©2012 Musher Group, LLC. All Rights Reserved.8

Examples of previous “Interactive” Codes: 90802 Interactive Psychiatric Diagnostic Evaluation 90810 Interactive Psychotherapy, 20- 30 mins 90811 Interactive Psychotherapy with E/M, 20-30 mins Interactive Complexity (+90785) Copyright ©2012 Musher Group, LLC. All Rights Reserved.9

“Interactive Complexity” extends the use to include other factors that complicate the delivery of a service to a patient. These include: Arguing or emotional family members in a session that interfere with providing the service Third party involvement with the patient, including parents, guardians, courts, schools, that interferes with providing the service Need for mandatory reporting of a sentinel event with discussion in the session Copyright ©2012 Musher Group, LLC. All Rights Reserved.11

90862 Pharmacologic Management has been ELIMINATED E/M codes will be used New code 90863 will be used by qualified psychologists with prescriptive authority in some jurisdictions. PHYSICIANS AND ADVANCED PRACTICE NURSES SHOULD NEVER USE 90863 Copyright ©2012 Musher Group, LLC. All Rights Reserved.15

Psychotherapy service codes remain time based. The patient must be present for all or some of the service (may include family members or others in the treatment process) When reported alone, they will be coded as 30, 45, or 60 minutes (90832, 90834, 90837) When reported with an E/M service by a qualified practitioner they will be coded as an Add On Code for 30, 45,or 60 minutes(+90833, +90836, +90838) Copyright ©2012 Musher Group, LLC. All Rights Reserved.18

CPT Time Rule “ A unit of time is attained when the mid- point is passed ” “ When codes are ranked in sequential typical times and the actual time is between two typical times, the code with the typical time closest to the actual time is used. ” As an example, codes of 30, 45, and 60 minutes are billed at 16-37 mins, 38- 52 mins, and 53-67 mins. (CPT 2013, p xii) Copyright ©2012 Musher Group, LLC. All Rights Reserved.19

When reporting an E/M service with an Add On Psychotherapy service (+90833, +90836, +90838) The E/M service is selected first (type and level) Level based on Elements, CANNOT use Time (Counseling and Coordination of Care) Time devoted to meeting the requirements of the E/M service cannot be used for the psychotherapy time A separate diagnosis is not needed for the reporting of the psychotherapy and E/M on the same date of service Copyright ©2012 Musher Group, LLC. All Rights Reserved.20

The Psychotherapy Add-On Codes can be billed with the following primary E/M Codes: Outpatient, established patient: 99212-99215 Subsequent hospital care 99231-99233 Subsequent nursing facility care 99307-99310 Copyright ©2012 Musher Group, LLC. All Rights Reserved.21

Putting it all together: E/M with Psychotherapy and Interactive Complexity (Can potentially bill 3 codes: E/M +Psychotherapy Add On + Interactive Complexity Add On) Copyright ©2012 Musher Group, LLC. All Rights Reserved.25

+90785 “with interactive complexity” Add On code may be used with: Diagnostic Codes (90791, 90792), Psychotherapy Codes (90832, 90834, 90837), Group psychotherapy (90853) As a second Add On code if a psychotherapy Add On code (90833, 90836, 90838) is used with an E/M Code 90785 may not be used with the Crisis Codes (90839, +90840) Copyright ©2012 Musher Group, LLC. All Rights Reserved.26

Crisis Psychotherapy Two new codes (90839, +90840) to be used when the presenting problem is “life threatening or complex and requires immediate attention to a patient in high distress” Copyright ©2012 Musher Group, LLC. All Rights Reserved.28

90839 Psychotherapy for crisis, first 60 minutes ADD ON CODE: +90840 each additional 30 minutes (list separately in addition to code for primary service) Copyright ©2012 Musher Group, LLC. All Rights Reserved.29

These codes are time based and include time face to face with the patient and/or family. The time does not have to be continuous, but must involve the full attention of the physician or other qualified healthcare professional to the patient and or family member. Services cannot be provided to any other patient during the time period billed under these codes Copyright ©2012 Musher Group, LLC. All Rights Reserved.30

90839 is used to report the first 30-74 minutes of psychotherapy for crisis ADD ON CODE +90840 should be reported for each additional 16-45 minutes Copyright ©2012 Musher Group, LLC. All Rights Reserved.31

RECAP: 2 New Diagnostic Evaluation Codes: 90791 (No medical services) 90792 (With medical services) 90862 Eliminated - Physicians and APRNs USE E/M Psychotherapy Codes Stand-Alone - 90832, 90834, 90837 Add-On with E/M - 90833, 90836, 90838 CPT TIME RULE 30 mins (16-37) 45 mins (38-52) 60 mins (53-67) Copyright ©2012 Musher Group, LLC. All Rights Reserved.32

RECAP: Add On Codes will be used for certain services: Interactive Complexity Psychotherapy Services when combined with E/M services Crisis Psychotherapy Add On for each additional 30 minutes Copyright ©2012 Musher Group, LLC. All Rights Reserved.33

HOW TO PREPARE Purchase a 2013 edition of the AMA CPT manual at www.amabookstore.com www.amabookstore.com Learn how to select & document E/M codes (99xxx series) Check out the Training sessions with documentation templates at MusherGroup.com Locate and review any contracts with commercial payers and Medicaid Watch the APA website for more information Copyright ©2012 Musher Group, LLC. All Rights Reserved.34

JEREMY S. MUSHER, MD, DFAPA PRESIDENT AND CEO MUSHER GROUP, LLC MUSHERGROUP.COM APA Advisor, AMA/Specialty Society RVS Update Committee (RUC) APA CPT Alternate.

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JEREMY S. MUSHER, MD, DFAPA PRESIDENT AND CEO MUSHER GROUP, LLC MUSHERGROUP.COM APA Advisor, AMA/Specialty Society RVS Update Committee (RUC) APA CPT Alternate.

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