Services and Procedures within the Medicine Section

Full Answer Section

       

1. Code: 90832
   • Description: Psychotherapy, 30 minutes with patient and/or family member (e.g., insight-oriented, behavior modifying and/or supportive psychotherapy).

Parenthetical Notes Associated with the Selected Codes: Based on standard CPT guidelines (and as typically found in the CPT manual for these codes):

• For 90837:
  • (Do not report 90837 in conjunction with 90833, 90834, 90836, 90838) - This note clarifies that 90837 (60-minute psychotherapy with E/M) should not be reported on the same day as other specific psychotherapy codes that might represent different durations or types of services. This prevents unbundling and ensures correct reporting.
  • (For psychotherapy provided with an E/M service for 30 minutes, use 90833. For psychotherapy provided with an E/M service for 45 minutes, use 90836.) - This note guides the coder to use the correct code based on the time spent when psychotherapy is combined with an E/M service, indicating that 90837 is specifically for the 60-minute combined service.
• For 90832:
  • (Do not report 90832 in conjunction with 90833, 90834, 90836, 90837, 90838) - Similar to 90837, this note prevents reporting 90832 (30-minute psychotherapy alone) with other psychotherapy codes that represent different durations or combined services.
  • (For psychotherapy provided with an E/M service for 30 minutes, use 90833.) - This note directs the coder to the appropriate combined code if an E/M service was also performed.

These parenthetical notes are crucial for correct code selection, preventing errors like unbundling or miscoding based on time spent and services rendered. Types of Modifiers Appropriate to Use with the Codes Selected: Modifiers provide additional information about the service performed without changing the meaning of the CPT code itself. For psychotherapy codes like 90837 and 90832, several modifiers may be appropriate depending on the specific circumstances of the service.

1. Modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of a Procedure or Other Service):
   • Application with 90832: This modifier would be highly relevant if an E/M service (e.g., office visit for medication management) was performed on the same day as the psychotherapy (90832) but was distinct and significant enough to warrant separate billing. For example, a psychiatrist might spend 30 minutes on psychotherapy (90832) and then conduct a separate, significant medication review and adjustment (E/M service) during the same visit. Modifier 25 would be appended to the E/M code, not the psychotherapy code, to indicate that the E/M service was separate from the psychotherapy.

Sample Answer

        Medicine Section Subheading of Interest: Psychiatry The Psychiatry section (90785-90899) of the CPT manual covers a broad range of services related to mental health, including diagnostic evaluations, psychotherapy, pharmacologic management, and other psychiatric services. This section is particularly interesting due to the nuanced nature of mental health care and the various modalities employed. Two Coding Examples from the Psychiatry Subheading:

1. Code: 90837
   • Description: Psychotherapy, 60 minutes with patient and/or family member (e.g., insight-oriented, behavior modifying and/or supportive psychotherapy); with evaluation and management service.
2.