Psychiatric Medical Billing & Coding Guidelines For 2021

During the pandemic, 4 out of 10 adults in the US reported symptoms of anxiety or depression. This is four times the number of people afflicted by mental health problems before the rise of the Covid-19 pandemic. Such statistics reveal that in these unprecedented and difficult times, more people are seeking mental health and psychotherapy services.

Mental healthcare practices must stay up to date with the help of professional psychiatric medical billing and coding services. With numerous medical billing codes, various combinations of evaluation and management solutions, and complex coding processes, psychiatric medical billing is not easy.

This article will cover the basics of coding and billing for psychiatric services with some of the most commonly used medical billing codes and provide the best tips on how to avoid claim denials.

How to Use the Correct Medical Billing Code in Psychiatry

Psychiatric medical coding and billing is a highly complex procedure that requires a precise and accurate selection of codes to be reimbursed for the costs of the healthcare services provided. Healthcare providers must also document these services to back up their claims based on the code they have selected.

It is common for healthcare professionals to feel intimidated by these codes, but therapists might not even need to use all of them. Nevertheless, they must memorize the right medical billing codes that they are likely to come across to streamline their billing process and maximize their revenues.

A therapist might bill for one or both of the following types of medical billing codes when treating a new patient:

• Psychiatric Diagnostic Evaluation Code: A psychiatric diagnostic evaluation code, CPT 90791, is commonly used when the psychiatrist makes an initial assessment of the patient and tries to infer a diagnosis.
• CPT code 90792 is used when a psychiatrist undertakes a diagnostic evaluation and provides medical services to the patient. A medical billing code may be used more than once or two different codes may be used if the initial evaluation takes more time or more than one sitting. To bill for this code, the psychiatrist must document their initial assessment of the patient’s condition in addition to the patient’s psychosocial history and their current mental status.

• Evaluation and management codes: E/M codes are used when a therapist evaluates a new medical issue with the patient. These E/M codes can be chosen based on the complexity of the medical decision-making process or the amount of time spent treating the patient on the day the E/M code was documented. However, if a psychiatrist provides E/M services to the patient in addition to psychotherapy services, they must choose the correct E/M CPT code based on the number and complexity of the problems revealed while talking with the patient, as well as the complexity of any data reviewed and the risk of complications.

Remember that an E/M code should only be documented with a psychotherapy service when a separate medical issue is furnished during the visit. The psychiatrist must also document this medical problem that is separate from the psychotherapy service. If no medical concerns arise during the psychotherapy visit, an E/M service cannot be billed.

Additionally, according to the AMA’s new 2021 coding rules, the amount of time spent treating the patient is not limited to only face-to-face interactions on the day of the encounter but also includes the time spent on their care away from the patient. This can include, for example, the time spent documenting the patient’s information in their electronic healthcare records.

Most Common Psychotherapy CPT Codes

Here are some of the most common psychotherapy CPT codes psychiatrists/therapists may have to bill for daily:

• CPT code 90832 – 30 minutes of individual psychotherapy (16-37 minutes).
• CPT code 90834 – 45 minutes of individual psychotherapy (38-52 minutes).
• CPT code 90837 – 60 minutes of individual psychotherapy (53 minutes and over).
• CPT code 90845 – Psychoanalysis.
• CPT code 90846 – Family or couples therapy in the patient’s absence (26 minutes or longer).
• CPT code 90847 – Family or couples therapy in the patient’s presence (26 minutes or longer).
• CPT code 90849 – Multiple family group psychotherapy.
• CPT code 90853 – Group psychotherapy (other than of a multiple-family group).

Apart from the aforementioned psychotherapy CPT codes, if a patient communicates a life-threatening or highly complex psychiatric crisis, the following psychotherapy CPT codes are used:

• 90839 – Psychotherapy for the crisis (first 60 minutes).
• 90840 – Add-on code for each additional 30 minutes of psychotherapy for the crisis.
• 99050 – Add-on code for emergency services provided when the office is usually closed.
• 99051 – Add-on code for services provided during regularly scheduled hours on evenings, weekends, or holidays.

Note that if a psychotherapy crisis session does not last for 60 minutes or more, the patient must be billed for a regular psychotherapy CPT code.

Add-On Codes

Therapists may draft a bill for additional codes on top of the principal psychotherapy CPT code when they provide extra services to the patient. Healthcare providers should list both the original CPT code and the add-on code on the billing form separately. Add-on codes include:

• CPT code 90833: 30 minutes of psychotherapy + Evaluation and Management.
• CPT code 90836: 45 minutes of psychotherapy + Evaluation and Management.
• CPT code 90838: 60 minutes of psychotherapy + Evaluation and Management.
• CPT code 90863: Psychopharmacology + psychotherapy.
• CPT code 90785: Interactive complexity.

CPT codes 90833, 90836, and 90838 are generally used to report both an E/M service and a psychotherapy service when the two services are significantly and separately identifiable. When using these add-on codes, time cannot be used as the basis of the E/M code selection.

CPT code 90785 is used when external factors interfere with the patient’s treatment such as a patient’s angry family member or the need for a translator, which further complicates the service. CPT code 90863 can only be used by psychologists when they prescribe or review any medication to the patient on the same day as they provide psychotherapy services.

Tips for Effectively Using Psychiatric Medical Billing Codes

Understanding medical billing codes is the key to streamlining your billing workflow and minimizing insurance claim denials in your practice. Unfortunately, many providers fail to reduce claim denials due to a lack of accuracy within their revenue cycle management system. The most common coding errors in the billing process include:

• Use of the wrong principal CPT code with an add-on code.
• Billing of in-patient codes for outpatient care.
• Billing of the same code twice for a single service.

It is always best to avoid these errors in coding as much as possible to prevent any delays in reimbursement. If any claim is denied, make sure to follow up on it and find out the reason for the rejection. It could be a simple human error on your part or it could be a huge gap in your billing system. Either way, reviewing your past mistakes could give you the insight you need to claim your reimbursements and steer clear of any future claim denials.

Moreover, always make sure that the documentation you have backs up the level of care that you are billing for. Without proper documentation, your claim will probably be denied if there is not enough evidence to support it.

See Also: What Does A Medical Billing And Coding’s Specialist Do?

Bottom line

The Bottom Line Your reimbursement rates rely heavily upon your medical billing and coding system which in turn depends upon your knowledge and understanding of medical billing codes. Psychiatric medical coding is a challenging task, and outsourcing it to an expert ensures that an experienced billing team is taking care of all your reimbursements.