How To Use CPT Code 90867

CPT 90867 is a code for therapeutic repetitive transcranial magnetic stimulation (TMS) treatment, including cortical mapping, motor threshold determination, delivery, and management. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 90867 procedures.

1. What is CPT 90867?

CPT 90867 is a medical billing code used for therapeutic repetitive transcranial magnetic stimulation (TMS) treatment. This noninvasive procedure uses magnetic fields to stimulate nerve cells in the brain, aiming to improve symptoms of depression in patients who do not respond to medications. The code covers the initial treatment, which includes cortical mapping, motor threshold determination, delivery, and management of the TMS procedure.

2. 90867 CPT code description

The official description of CPT code 90867 is: “Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management.”

3. Procedure

The 90867 procedure involves the following steps:

1. Preparation of the patient, including positioning and ensuring comfort.
2. Placement of an electromagnetic coil over the patient’s scalp, targeting an area of the brain involved in mood regulation.
3. Administration of magnetic impulses in rapid succession, stimulating neurons and producing long-lasting changes in brain activity.
4. Cortical mapping to identify the specific brain regions targeted during the procedure.
5. Determination of the motor threshold, which is the minimum intensity of stimulation required to produce a motor response.
6. Delivery of the TMS treatment, adjusting the intensity and duration as needed based on the patient’s response.
7. Management of the patient’s care throughout the procedure, including monitoring for any adverse effects and providing support as needed.

4. Qualifying circumstances

Patients eligible to receive CPT code 90867 services are those who:

• Have a diagnosis of major depressive disorder.
• Have not responded to at least one adequate trial of antidepressant medication.
• Are not currently experiencing a psychotic episode.
• Do not have any contraindications to TMS treatment, such as a history of seizures or the presence of metal implants in the head.
• Have been evaluated by a qualified healthcare professional who has determined that TMS is an appropriate treatment option for their condition.

5. When to use CPT code 90867

It is appropriate to bill the 90867 CPT code when a qualified healthcare professional performs the initial TMS treatment for a patient who meets the qualifying circumstances outlined above. This code should only be used for the initial treatment, which includes cortical mapping, motor threshold determination, delivery, and management of the TMS procedure.

6. Documentation requirements

To support a claim for CPT 90867, the following information should be documented:

• Patient’s diagnosis of major depressive disorder.
• History of inadequate response to at least one trial of antidepressant medication.
• Evaluation by a qualified healthcare professional, including the determination that TMS is an appropriate treatment option.
• Details of the TMS procedure, including cortical mapping, motor threshold determination, delivery, and management.
• Any adverse effects experienced by the patient during the procedure and how they were managed.
• Outcome of the initial TMS treatment, including any improvements in the patient’s depressive symptoms.

7. Billing guidelines

When billing for CPT code 90867, it is important to follow the appropriate guidelines and rules. This code should only be used for the initial TMS treatment, and it should not be reported in conjunction with codes 90868, 90869, 95860, 95870, 95928, 95929, or 95939. For peripheral nerve transcutaneous magnetic stimulation, use codes 0766T, 0767T, 0768T, or 0769T instead.

8. Historical information

CPT 90867 was added to the Current Procedural Terminology system on January 1, 2011. The code was changed on January 1, 2012, with the previous descriptor being “Therapeutic repetitive transcranial magnetic stimulation treatment; planning.”

9. Similar codes to CPT 90867

Five similar codes to CPT 90867 and how they differentiate are:

• CPT 90868: This code is used for subsequent TMS treatments, not including cortical mapping or motor threshold determination.
• CPT 90869: This code is for a TMS re-evaluation, which may include cortical mapping and motor threshold determination if clinically indicated.
• CPT 95860: This code is for needle electromyography, which is a diagnostic procedure that evaluates muscle and nerve function.
• CPT 95928: This code is for central motor evoked potential (MEP) studies, which assess the function of the central motor pathways.
• CPT 95939: This code is for unlisted central nervous system services or procedures, which may include novel or experimental treatments not otherwise specified in the CPT code set.

10. Examples

Here are 10 detailed examples of CPT code 90867 procedures:

1. A 35-year-old patient with a history of treatment-resistant depression undergoes an initial TMS treatment, including cortical mapping, motor threshold determination, delivery, and management.
2. A 50-year-old patient with major depressive disorder who has not responded to multiple antidepressant medications receives their first TMS treatment, including all necessary components.
3. A 28-year-old patient with a diagnosis of major depressive disorder undergoes an initial TMS treatment after a thorough evaluation by a qualified healthcare professional.
4. A 45-year-old patient with a history of depression and inadequate response to medication receives their first TMS treatment, including cortical mapping and motor threshold determination.
5. A 60-year-old patient with major depressive disorder undergoes an initial TMS treatment after other treatment options have been exhausted.
6. A 32-year-old patient with treatment-resistant depression receives their first TMS treatment, including delivery and management of the procedure.
7. A 40-year-old patient with a diagnosis of major depressive disorder undergoes an initial TMS treatment, including cortical mapping and motor threshold determination, after a thorough evaluation by a qualified healthcare professional.
8. A 55-year-old patient with a history of depression and inadequate response to medication receives their first TMS treatment, including all necessary components of the procedure.
9. A 38-year-old patient with major depressive disorder undergoes an initial TMS treatment after other treatment options have been exhausted and a qualified healthcare professional has determined TMS to be an appropriate option.
10. A 47-year-old patient with treatment-resistant depression receives their first TMS treatment, including delivery and management of the procedure, after a thorough evaluation by a qualified healthcare professional.