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A psychiatric diagnostic interview examination is the elicitation of a complete medical and psychiatric history (including past, family and social), completion of a comprehensive mental status exam, establishment of a tentative diagnosis, and an evaluation of the patient's ability and willingness to work to solve the patient's mental problem.
An interactive medical psychiatric diagnostic interview is an initial evaluation typically furnished to children. This interview involves the use of physical aids and non-verbal communication to overcome barriers to therapeutic action between the clinician and the patient who has not yet developed, or has lost, either the expressive language communication skills to understand the clinician if he/she were to use ordinary adult language for communication.
CPT codes for Psychiatric Services
90801 Psychiatric diagnostic interview examination
90802 Interactive psychiatric diagnostic interview examination using play equipment, physical devices, language interpreter, or other mechanisms of communication
90804-90809 Insight oriented, behavior modifying and or supportive psychotherapy
90810-90815 Interactive Psychotherapy
90846 Family Psychotherapy (without the patient present)
90847 Family Psychotherapy (with the patient present)
90849 Multiple-family group psychotherapy
90853 Group psychotherapy (other than of a multiple-family group)
90857 Interactive group psychotherapy
Appropriate Place of Service Codes for Psychiatric Services
04 Homeless Shelter
12 Patient’s Home
14 Group Home
20 Urgent Care
22 Outpatient Hospital
23 Emergency Room - Hospital
49 Independent Clinic
53 Community Mental Health Center
62 Comprehensive Outpatient Rehabilitation Facility (CORF)
Coding guidelines for Psychiatric Services
Psychotherapy codes that include an E/M component (90805, 90807, 90809, 90811, 90813, 90815, 90817, 90819, 90822, 90824, 90827 and 90829) are payable only to Doctors of Medicine (MDs), Doctors of Osteopathy (DOs), qualified CNSs, NPs and PAs. Each element of these services (therapy and E/M) must be reasonable and necessary and should be documented in the patient’s records.
Psychiatrists, clinical psychologists, NPs, PAs and CSWs may bill codes 90801, 90802, 90804, 90806, 90808, 90810, 90812, 90814, 90816, 90818, 90821, 90823, 90826, 90828, 90845, 90846, 90847, 90853, 90857 and 90880.
Clinical Nurse Specialists (CNSs) may bill codes 90801, 90802, 90804–90829, 90846, 90847, 90853 and 90857. Psychoanalysis (90845) is not covered for CNSs.
Psychiatric nurse practitioners may bill for CPT codes 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90810, 90811, 90812, 90813, 90814, 90815, 90816, 90817, 90818, 90819, 90821, 90822, 90823, 90824, 90826, 90827, 90828, 90829, 90846, 90847, 90849, 90853 and 90857 if they are trained and authorized to perform these psychiatric services.
Codes for psychotherapy with E/M services (90805, 90807, 90809, 90811, 90813, 90815, 90817, 90819, 90822, 90824, 90827, 90829) should be used when psychotherapy is performed and there is an appropriate level of E/M service that is medically necessary and separately performed. For example, the E/M service could involve medical diagnostic evaluation, drug management, physician orders, and/or interpretation of laboratory tests or other diagnostic studies and observations.
Similar services on the same day are not permitted to multiple providers in the same specialty for the same diagnosis.
Medicare will not accept psychotherapy procedure codes 90804–90829 billed on the same day of service as an E/M service by the same provider.
Interactive psychotherapy codes 90810–90815 and 90823–90829 should not be billed on the same dates of service as regular psychotherapy codes 90804–90809 or 90816–90822.
Procedure codes 90808, 90809, 90814, 90815, 90821, 90822, 90828 and 90829 represent services lasting approximately 75 to 80 minutes. The provider must document in the patient’s medical record the medical necessity of these services and define the extended services. Medicare anticipates that these extended services will be used in times of exceptional need.
Psychotherapy services are never covered for severe and profound mental retardation (ICD-9-CM codes 318.1 and 318.2).
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