How To Use CPT Code 90868

CPT 90868 refers to therapeutic repetitive transcranial magnetic stimulation (TMS) treatment, specifically for subsequent delivery and management, per session. TMS is a non-invasive procedure that utilizes magnetic fields to stimulate nerve cells in the brain, primarily aimed at alleviating symptoms of depression in patients who have not responded adequately to traditional medication therapies. This innovative approach allows healthcare providers to target specific areas of the brain associated with mood regulation, offering a promising alternative for individuals struggling with treatment-resistant depression.

1. What is CPT code 90868?

CPT code 90868 represents the subsequent delivery and management of therapeutic repetitive transcranial magnetic stimulation (TMS) treatment, per session. TMS is a cutting-edge, non-invasive technique that employs magnetic fields to stimulate neurons in the brain. This procedure is particularly relevant in the context of treating major depressive disorder, especially for patients who have not found relief through conventional pharmacological treatments. The purpose of this code is to facilitate the billing and documentation of follow-up sessions where TMS is administered, ensuring that healthcare providers can effectively manage and track the treatment progress of their patients. The clinical relevance of this code lies in its ability to provide a structured approach to ongoing TMS therapy, which can lead to significant improvements in mood and overall mental health for individuals suffering from depression.

2. Qualifying Circumstances

This CPT code can be used in specific circumstances where a patient has undergone initial TMS treatment and is returning for subsequent sessions. It is essential that the patient has been appropriately evaluated and deemed suitable for ongoing TMS therapy. The use of this code is appropriate in clinical scenarios where patients exhibit persistent depressive symptoms despite prior treatment attempts, including medication and psychotherapy. However, it is important to note that this code should not be used for initial TMS sessions, as it is designated specifically for follow-up treatments. Additionally, providers must ensure that they are adhering to the guidelines set forth by insurance carriers regarding the frequency and duration of TMS sessions to avoid potential billing issues.

3. When To Use CPT 90868

CPT code 90868 is utilized during follow-up appointments where the provider administers TMS therapy to a patient who has already begun treatment. This code is specifically for subsequent sessions, meaning it cannot be used for the initial TMS treatment, which would require a different code. Providers should document the patient’s progress and response to therapy during each session, as this information is crucial for ongoing management and may influence future treatment decisions. It is also important to note that this code should not be billed in conjunction with certain other codes related to psychiatric evaluations or initial treatment sessions, as this could lead to billing discrepancies.

4. Official Description of CPT 90868

Official Descriptor: Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent delivery and management, per session.

5. Clinical Application

CPT code 90868 is applied in the clinical setting for patients undergoing therapeutic repetitive transcranial magnetic stimulation (TMS) treatment. The primary purpose of this service is to provide ongoing management and delivery of TMS therapy, which has been shown to be effective in treating depression, particularly in cases where patients have not responded to traditional antidepressant medications. The importance of this procedure lies in its ability to offer a non-invasive alternative for patients, potentially leading to significant improvements in their mental health and quality of life. By utilizing this code, healthcare providers can ensure that they are accurately documenting and billing for the ongoing treatment sessions that are critical for the patient’s recovery process.

5.1 Provider Responsibilities

During the TMS procedure, the provider has several key responsibilities. Initially, they must ensure that the patient is properly prepared for the session, which includes confirming that the patient has not taken any contraindicated medications and that they understand the procedure. The provider then places an electromagnetic coil over the patient’s scalp, targeting the specific area of the brain associated with mood regulation. Throughout the session, the provider administers magnetic impulses in rapid succession, monitoring the patient for any adverse reactions and adjusting the treatment parameters as necessary. After the session, the provider must document the patient’s response to the treatment and any changes in symptoms, which is essential for ongoing management and future treatment planning.

5.2 Unique Challenges

One of the unique challenges associated with TMS therapy is ensuring patient compliance and comfort during the procedure. Some patients may experience discomfort or anxiety related to the magnetic impulses, which can affect their willingness to continue with treatment. Additionally, providers must be vigilant in monitoring for any potential side effects, such as headaches or scalp discomfort, which can occur during or after the session. Another challenge is the need for ongoing assessment of the patient’s progress, as the effectiveness of TMS can vary widely among individuals. Providers must be prepared to adjust treatment plans based on the patient’s response, which requires careful documentation and communication.

5.3 Pre-Procedure Preparations

Before administering TMS therapy, the provider must conduct a thorough evaluation of the patient’s medical history and current mental health status. This includes assessing the patient’s previous treatment attempts, including medications and psychotherapy, to determine the appropriateness of TMS as a treatment option. The provider should also discuss the procedure with the patient, explaining what to expect during the session and addressing any concerns they may have. Additionally, it is important to ensure that the patient has not consumed any substances that could interfere with the treatment, such as caffeine or certain medications, prior to the session.

5.4 Post-Procedure Considerations

After the TMS session, the provider must monitor the patient for any immediate side effects and assess their overall response to the treatment. Follow-up care may include scheduling additional sessions and providing the patient with resources for managing any discomfort they may experience. It is also crucial for the provider to document the outcomes of the session, including any changes in the patient’s symptoms and overall mental health status. This information is vital for evaluating the effectiveness of the treatment and making informed decisions about future sessions.

6. Relevant Terminology

Transcranial Magnetic Stimulation (TMS): A non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain, primarily used to treat depression.

Electromagnetic Coil: A device used in TMS that generates magnetic fields to stimulate specific areas of the brain.

Neurons: Nerve cells in the brain that transmit information and play a crucial role in mood regulation.

Major Depressive Disorder: A mental health condition characterized by persistent feelings of sadness and loss of interest, often requiring treatment.

Pharmacological Treatments: Medications prescribed to manage mental health conditions, including antidepressants.

7. Clinical Examples

1. A patient with major depressive disorder who has not responded to multiple antidepressant medications seeks alternative treatment options.

2. A healthcare provider evaluates a patient who has completed an initial course of TMS and is returning for follow-up sessions to monitor progress.

3. A patient experiences mild discomfort during their TMS session, prompting the provider to adjust the treatment parameters for comfort.

4. A provider documents significant improvement in a patient’s mood after several TMS sessions, leading to a discussion about continuing treatment.

5. A patient expresses anxiety about the TMS procedure, and the provider takes time to explain the process and address concerns.

6. A patient reports headaches following their TMS session, and the provider monitors their symptoms and provides guidance on management.

7. A provider collaborates with a psychiatrist to evaluate the effectiveness of TMS in conjunction with ongoing psychotherapy for a patient.

8. A patient who has undergone TMS therapy for several weeks shares their experience of improved energy levels and mood stability.

9. A healthcare team reviews a patient’s treatment plan to determine if adjustments are needed based on their response to TMS.

10. A provider schedules a follow-up appointment to assess the long-term effects of TMS on a patient’s mental health after completing the treatment course.