Time is Key Factor in Psychotherapy Coding

When time is the controlling factor in a patient’s visit, be sure to capture the appropriate time-based service code. According to CPT®, unless there are code or code-range-specific guidelines, parenthetical instructions, or code descriptors to the contrary, the following standards apply to time measurement:

A unit of time is attained when the midpoint is passed. For example, an hour is attained when 31 minutes have elapsed (more than midway between zero and 60 minutes). A second hour is attained when 91 minutes have elapsed.

When codes are ranked in sequential typical times, and the actual time is between two typical times, use the code with the typical time closest to the actual time.

All mental health professionals including psychologists, psychiatrists, nurses, and social workers delivering psychotherapy services use the same applicable CPT codes when billing clients and filing health insurance claims with third-party payers, including Medicare, Medicaid, and private health insurance carriers. All individual psychotherapy will be captured through one of three (3) following codes:

• 90832: Psychotherapy, 30 minutes with patient
• 90834: Psychotherapy, 45 minutes with patient
• 90837: Psychotherapy, 60 minutes with patient

Family or group psychotherapy will be captured through one of four (4) following codes:

• 90846: Family psychotherapy (without the patient present), 50 minutes
• 90847: Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes
• 90849: Multiple-family group psychotherapy
• 90853: Group psychotherapy (other than of a multiple-family group)

Record Actual Time of Session

The precise amount of time associated with CPT codes may well differ from the genuine time providers provided psychotherapy. In general, providers should select the code that most closely matches the actual time you spent. The CPT manual provides for flexibility by identifying time ranges in the descriptions of the three codes, as follows:

• 90832: 16 to 37 minutes
• 90846, 90847: 26 or more minutes
• 90834: 38 to 52 minutes
• 90837: 53 minutes or longer

Please note that the psychotherapy codes should not be billed for any sessions lasting less than 16 minutes. As part of adequate documentation of patient encounters in the record, be sure to note start and stop times for every session of psychotherapy you provide. From an insurance company’s standpoint, if you don’t record these details, you didn’t deliver the service.

Psychotherapy Crisis Codes

• CPT code 90839 is the principal code for a crisis psychotherapy session requiring urgent assessment and history of the crisis state, mental status exam and disposition. It is billed for the first 60 minutes of psychotherapy for a patient in crisis.
• If/when the crisis psychotherapy session lasts longer than 60 minutes, the add-on code, 90840, can be billed for each additional 30 minutes of psychotherapy for crisis.
• In order for the new crisis codes to apply, the presenting problem must typically be life -threatening or complex and require immediate attention to a patient in high distress.