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prolonged services for mental health

Jennifer Posted Thu 07th of February, 2013 13:34:35 PM

If a patient was seen for mental health counseling- and the service extends 180 minutes or so - how to code ? The base would be 90808 but the prolonged code of 99354 must be used with 90809. There is no e and m services here. Will most insurances pay for two visits on same day- if that was the case ?

Jennifer Posted Fri 08th of February, 2013 22:15:00 PM

anyone ??

SuperCoder Answered Fri 08th of February, 2013 22:58:23 PM

90808 and 90809 are deleted codes for 2013.

You will have to begin using new code sets for psychotherapy services that have been performed on or after Jan.1, 2013. You will have to use the following codes if only psychotherapy services have been provided:

90832 (Psychotherapy, 30 minutes with patient and/or family member)

90834 (Psychotherapy, 45 minutes with patient and/or family member)

90837 (Psychotherapy, 60 minutes with patient and/or family member)

If your psychiatrist provided both evaluation and management services and psychotherapy in the same session, you will have to report the appropriate E/M code (based on the components and setting) along with the following add-on codes for psychotherapy:

+90833 (Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service [List separately in addition to the code for primary procedure])

+90836 (Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service [List separately in addition to the code for primary procedure])

+90838 (Psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service [List separately in addition to the code for primary procedure])

Since the new set of codes follow exact times and not time ranges like the older codes, you will have to use the CPT® time rules to report the right codes.

99354 being an add-on-code,you can use 99354 in conjunction with 90837 here.

Jennifer Posted Mon 11th of February, 2013 13:50:54 PM

Thank you ! I see in the code descriptor that you can use 99354 with 90837- but is this a misprint ? 90837 does not include e&m service, but 90838 does.... ???

SuperCoder Answered Fri 22nd of February, 2013 14:13:21 PM

If Psych. service is provided along with E/M service, then you do not code 90837, instead you should use +90838. Since this is an add-on code, use a primary CPT code which should be an E/M code. The parenthetical notes below to code +90838 suggests:

"Use 90838 in conjunction with 99201-99255, 99304-99337, 99341-99350".

"Use appropriate prolonged services code [99354-99357] for psychotherapy services 68 minutes or longer".

So you can code E/M code 99xxx, 90838, 99354-99357 (prolonged).

You can refer to the guideline jusr=t before the code segment 90832 in CPT manual.

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