Document Time for Psychotherapy Services

When the psychiatry and psychotherapy CPT codes underwent revision on Jan. 1, 2013, TMA's Payment Advocacy Department received a lot of calls for guidance. Apparently, confusion about the codes still exists, as Medicare's Comprehensive Error Rate Testing (CERT) program has uncovered "many improper payments" involving these codes.

The main error that CERT has identified with the revised codes is not clearly documenting the amount of time spent only on psychotherapy services. You must select the correct evaluation and management (E&M) service code based on the elements of the history and exam and medical decisionmaking required by the complexity/intensity of the patient's condition. Choose a psychotherapy code on the basis of the time spent providing psychotherapy. 

When a patient receives an E&M service with a psychotherapeutic service on the same day, by the same physician, Medicare will pay for both services if they are significant and separately identifiable and billed using the correct codes. New add-on codes (in the bulleted list below) designate psychotherapeutic services performed with E&M codes. An add-on code (often designated with a "+" in codebooks) describes a service performed with another primary service. An add-on code is eligible for payment only if you report it with an appropriate primary service performed on the same date of service. 

Time spent for the E&M service is separate from the time spent providing psychotherapy, and you cannot use time spent providing psychotherapy to meet criteria for the E&M service. Because time is indicated in the code descriptor for the psychotherapy CPT codes, it is important to clearly document in the patient's medical record the time you spent providing the psychotherapy service rather than entering one period including the E&M service.

 For psychotherapy services provided with an E&M service, use these codes:

  • Code + 90833: Psychotherapy, 30 minutes with patient and/or family member when performed with an E&M service (list separately in addition to the code for primary procedure);
  • Code + 90836: Psychotherapy, 45 minutes with patient and/or family member when performed with an E&M service (list separately in addition to the code for primary procedure); and
  • Code + 90838: Psychotherapy, 60 minutes with patient and/or family member when performed with an E&M service (list separately in addition to the code for primary procedure).

Example: A geriatric psychiatrist billed for a level 3 E&M service (99213) and 45 minutes of psychotherapy (90836). The medical record contained one entry for the date of service and, at the top, a notation: "45 minutes." It did not indicate whether the 45 minutes was spent providing the psychotherapy services or both services.

Medicare says: An overpayment for the psychotherapy service and a billing error occur when there is no separate entry for the amount of time spent performing psychotherapy services.

For psychotherapy services provided without an E&M service, the correct code depends on the time spent with the beneficiary:

  • Code 90832: Psychotherapy, 30 minutes with patient and/or family member;
  • Code 90834: Psychotherapy, 45 minutes with patient and/or family member; and
  • Code 90837: Psychotherapy, 60 minutes with patient and/or family member.

In general, select the code that most closely matches the actual time you spent performing psychotherapy. CPT provides flexibility by identifying time ranges that may be associated with each of the three codes:

  • Code 90832 (or + 90833): 16 to 37 minutes,
  • Code 90834 (or + 90836): 38 to 52 minutes, or
  • Code 90837 (or + 90838): 53 minutes or longer

Do not bill psychotherapy codes for sessions lasting less than 16 minutes.

Psychotherapy codes are no longer dependent on the service location (i.e., office, hospital, residential setting, or other location is not a factor). However, effective Jan. 1, 2014 (PDF), when E&M services are paid under Medicare's Partial Hospitalization Program and not in the physician office setting, the CPT outpatient visit codes 99201-99215 have been replaced with one Level II HCPCS code  G0463.

 For more information, see:

    • LCD L32766 — Psychiatric Codes, and
    • LCD L32705 — Partial Hospitalization Programs (PHPs) - Psychiatric.
     

If you have questions about billing and coding or payer policies, contact the specialists at paymentadvocacy@texmed.org for help, or call the TMA Knowledge Center at (800) 880-7955. TMA members can use the TMA Hassle Factor Log to help resolve insurance-related problems.

Published April 8, 2014

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