How To Use CPT Code 90785

CPT 90785 describes the use of interactive complexity in conjunction with primary psychiatric evaluation, psychotherapy, and group psychotherapy services. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 90785?

CPT 90785 is an add-on code that represents increased work intensity in psychotherapy services. It is used to describe communication factors that add difficulty to the delivery of service during a treatment session. These factors may include high reactivity or disagreement among family members, caregiver behavior that hinders treatment execution, situations involving abuse or neglect that require legal reporting, use of play equipment or objects for communication assistance, or the need for an interpreter or translator due to the patient’s lack of fluency or undeveloped verbal skills.

2. Official Description

The official description of CPT code 90785 is: ‘Interactive complexity (List separately in addition to the code for primary procedure).’ This code is used in conjunction with diagnostic psychiatric evaluation, psychotherapy, and group psychotherapy services. It should not be reported with psychological and neuropsychological testing or E/M services when no psychotherapy service is also reported.

3. Procedure

1. During a treatment session, the provider encounters communication factors that add difficulty to the delivery of service.
2. These factors may include high reactivity or disagreement among family members, caregiver behavior that hinders treatment execution, situations involving abuse or neglect that require legal reporting, use of play equipment or objects for communication assistance, or the need for an interpreter or translator due to the patient’s lack of fluency or undeveloped verbal skills.
3. The provider must navigate these interactive complexities while delivering the primary psychiatric evaluation, psychotherapy, or group psychotherapy service.
4. The use of CPT code 90785 indicates the increased intensity of effort required by the provider in these specific treatment sessions.

4. Qualifying circumstances

CPT 90785 is used when there are communication factors that add difficulty to the delivery of service during a treatment session. These factors may include high reactivity or disagreement among family members, caregiver behavior that hinders treatment execution, situations involving abuse or neglect that require legal reporting, use of play equipment or objects for communication assistance, or the need for an interpreter or translator due to the patient’s lack of fluency or undeveloped verbal skills. It is important to note that CPT 90785 should not be reported with psychological and neuropsychological testing or E/M services when no psychotherapy service is also reported.

5. When to use CPT code 90785

CPT code 90785 should be used when there are communication factors that add difficulty to the delivery of service during a treatment session. It is important to ensure that an appropriate primary psychotherapy or evaluation and management services code is also reported in conjunction with CPT 90785. This add-on code should not be reported without a primary code.

6. Documentation requirements

To support a claim for CPT 90785, the provider must document the following information:

• Communication factors that added difficulty to the delivery of service during the treatment session
• Specific details of the interactive complexities encountered
• Date and duration of the treatment session
• Primary psychiatric evaluation, psychotherapy, or group psychotherapy service code reported in conjunction with CPT 90785
• Progress made by the patient during the session, if applicable
• Signature of the provider delivering the service

7. Billing guidelines

When billing for CPT 90785, ensure that it is reported in conjunction with an appropriate primary psychiatric evaluation, psychotherapy, or group psychotherapy service code. This add-on code should not be reported without a primary code. It should also not be reported with psychological and neuropsychological testing or E/M services when no psychotherapy service is also reported.

8. Historical information

CPT 90785 was added to the Current Procedural Terminology system on January 1, 2013. There have been no updates to the code since its addition.

9. Examples

1. A therapist providing psychotherapy to a child with behavioral issues while also addressing communication difficulties among family members.
2. A psychiatrist conducting a diagnostic psychiatric evaluation for a patient with a history of trauma, while also navigating language barriers with the help of an interpreter.
3. A psychologist leading a group therapy session for individuals with substance use disorders, while also managing conflicts and disagreements among group members.
4. A social worker providing psychotherapy to a patient with depression, while also addressing concerns related to abuse or neglect that require legal reporting.
5. A counselor conducting a psychotherapy session for a patient with anxiety, while also utilizing play equipment to facilitate communication with a child.
6. A therapist providing psychotherapy to a patient with autism, while also addressing communication difficulties and the need for an interpreter due to the patient’s lack of fluency.
7. A psychiatrist conducting a diagnostic psychiatric evaluation for a patient with bipolar disorder, while also managing high reactivity and emotional outbursts during the session.
8. A psychologist leading a group therapy session for individuals with eating disorders, while also addressing conflicts and disagreements among group members.
9. A social worker providing psychotherapy to a patient with post-traumatic stress disorder, while also managing caregiver behavior that hinders treatment execution.
10. A counselor conducting a psychotherapy session for a patient with substance use disorder, while also addressing communication difficulties and the need for an interpreter due to the patient’s lack of fluency.