How To Use CPT Code 90869

CPT 90869 describes the subsequent motor threshold re-determination with delivery and management of therapeutic repetitive transcranial magnetic stimulation (TMS) treatment. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 90869?

CPT 90869 can be used to describe the subsequent motor threshold re-determination with delivery and management of therapeutic repetitive transcranial magnetic stimulation (TMS) treatment. This code is used when the provider performs a redetermination of the minimum intensity of electrical pulses necessary to elicit the desired response in brain activity for a patient undergoing TMS treatment. The provider then delivers and manages the therapy based on their findings.

2. Official Description

The official description of CPT code 90869 is: ‘Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; subsequent motor threshold re-determination with delivery and management.’

3. Procedure

1. The provider prepares the patient for the subsequent motor threshold re-determination with delivery and management of TMS treatment.
2. The provider places the TMS device over the patient’s scalp, targeting the limbic area of the brain.
3. The provider generates electric pulses in rapid succession using the TMS device, which produces changes in brain activity.
4. The provider redetermines the motor threshold, which is the minimum intensity of electrical pulses that elicits the desired response in brain activity.
5. Based on the redetermination, the provider delivers and manages the therapeutic TMS treatment for the patient.

4. Qualifying circumstances

CPT 90869 is used for patients who are undergoing therapeutic TMS treatment and require a subsequent redetermination of the motor threshold. This code should not be reported in conjunction with CPT codes 90867, 90868, 95860-95870, 95928, 95929, or 95939. Evaluation and management activities directly related to cortical mapping, motor threshold determination, delivery, and management of TMS are not separately reported.

5. When to use CPT code 90869

CPT code 90869 should be used when the provider performs a subsequent motor threshold re-determination with delivery and management of therapeutic TMS treatment. This code should not be reported if a significant, separately identifiable evaluation and management, medication management, or psychotherapy service is performed. In such cases, the appropriate E/M or psychotherapy code may be reported in addition to CPT codes 90867-90869.

6. Documentation requirements

To support a claim for CPT code 90869, the provider must document the following information:

• Patient’s diagnosis and the need for subsequent motor threshold re-determination
• Date and time of the procedure
• Details of the motor threshold re-determination process
• Delivery and management of the therapeutic TMS treatment
• Any significant, separately identifiable evaluation and management, medication management, or psychotherapy services performed
• Signature of the provider

7. Billing guidelines

When billing for CPT code 90869, ensure that the subsequent motor threshold re-determination with delivery and management of therapeutic TMS treatment is performed. Do not report this code in conjunction with CPT codes 90867, 90868, 95860-95870, 95928, 95929, or 95939. If a significant, separately identifiable evaluation and management, medication management, or psychotherapy service is performed, report the appropriate E/M or psychotherapy code in addition to CPT codes 90867-90869.

8. Historical information

CPT code 90869 was added to the Current Procedural Terminology system on January 1, 2012. There have been no updates to the code since its addition.

9. Examples

1. A psychiatrist performs a subsequent motor threshold re-determination with delivery and management of therapeutic TMS treatment for a patient with treatment-resistant depression.
2. A neurologist delivers and manages therapeutic TMS treatment for a patient with chronic pain, performing a subsequent motor threshold re-determination based on the patient’s response.
3. A psychologist performs a subsequent motor threshold re-determination with delivery and management of therapeutic TMS treatment for a patient with obsessive-compulsive disorder.
4. A psychiatrist provides a subsequent motor threshold re-determination with delivery and management of therapeutic TMS treatment for a patient with bipolar disorder.
5. A neurologist delivers and manages therapeutic TMS treatment for a patient with Parkinson’s disease, performing a subsequent motor threshold re-determination to optimize treatment efficacy.
6. A psychologist performs a subsequent motor threshold re-determination with delivery and management of therapeutic TMS treatment for a patient with post-traumatic stress disorder.
7. A psychiatrist provides a subsequent motor threshold re-determination with delivery and management of therapeutic TMS treatment for a patient with schizophrenia.
8. A neurologist delivers and manages therapeutic TMS treatment for a patient with migraines, performing a subsequent motor threshold re-determination to tailor the treatment to the patient’s needs.
9. A psychologist performs a subsequent motor threshold re-determination with delivery and management of therapeutic TMS treatment for a patient with generalized anxiety disorder.
10. A psychiatrist provides a subsequent motor threshold re-determination with delivery and management of therapeutic TMS treatment for a patient with substance use disorder and co-occurring depression.