How To Use CPT Code 90870

CPT 90870 describes the procedure of electroconvulsive therapy (ECT) for the treatment of various mental disorders. 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 90870?

CPT 90870 can be used to describe the application of an electric current to a patient’s brain to induce a seizure or series of seizures for the purpose of alleviating symptoms of mental disorders. This procedure, known as electroconvulsive therapy (ECT), is typically performed when conventional treatments have been ineffective. ECT primarily targets depression but may also be considered for other conditions, such as life-threatening psychoses or when rapid symptom relief is necessary. The code includes the evaluation, monitoring, and management of the patient during the convulsive and recovery phases of the procedure.

2. Official Description

The official description of CPT code 90870 is: ‘Electroconvulsive therapy (includes necessary monitoring); single seizure.’

3. Procedure

1. The patient is prepared and anesthetized by the provider.
2. The provider, usually a trained psychiatrist, applies an electric current to the patient’s brain through scalp electrodes.
3. The electric current is delivered for a fraction of a second, intentionally triggering a brief seizure.
4. The seizure typically lasts less than 60 seconds.
5. The provider monitors the patient during the convulsive phase, including electroencephalographic tracing and observation.
6. The provider also manages the recovery phase, monitoring the patient’s condition and making decisions regarding further treatment.

4. Qualifying circumstances

CPT 90870 is performed on patients who have not responded to conventional treatments for mental disorders. It is primarily used for the treatment of depression but may be considered for other conditions, such as life-threatening psychoses. The procedure is typically performed by a trained psychiatrist. The code includes the evaluation, monitoring, and management of the patient during the convulsive and recovery phases of the procedure.

5. When to use CPT code 90870

CPT code 90870 should be used when electroconvulsive therapy is performed to alleviate symptoms of mental disorders that have not responded to other treatments. It is important to ensure that the patient meets the qualifying circumstances for this procedure. The code should only be reported once per session.

6. Documentation requirements

To support a claim for CPT 90870, the provider must document the following information:

• Patient’s diagnosis and the need for electroconvulsive therapy
• Details of the procedure, including the application of the electric current and the duration of the seizure
• Monitoring and management of the patient during the convulsive and recovery phases
• Decision-making regarding further treatment
• Any significant and separately identifiable evaluation and management services provided on the same day, if applicable

7. Billing guidelines

When billing for CPT 90870, report one unit of the code per session. If the provider also evaluates the patient for a significant and separately identifiable evaluation and management service, it can be reported with the appropriate established patient E/M code using a modifier such as 25. However, CPT code 90870 cannot be reported together with the psychodiagnostic evaluation code 90792 for physician services. It is important to review the specific billing guidelines and modifiers applicable to your practice.

8. Historical information

CPT 90870 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A psychiatrist performing electroconvulsive therapy on a patient with treatment-resistant depression.
2. A provider using electroconvulsive therapy to alleviate symptoms of a life-threatening psychosis in a patient who is at risk of self-harm or harm to others.
3. A psychiatrist administering electroconvulsive therapy to a patient with severe bipolar disorder.
4. A provider using electroconvulsive therapy as a rapid intervention for a patient with catatonia.
5. A psychiatrist performing electroconvulsive therapy on a patient with persistent and severe major depressive disorder.
6. A provider using electroconvulsive therapy to treat a patient with schizophrenia who is experiencing severe hallucinations and delusions.
7. A psychiatrist administering electroconvulsive therapy to a patient with treatment-resistant obsessive-compulsive disorder.
8. A provider using electroconvulsive therapy to alleviate symptoms of a life-threatening manic episode in a patient with bipolar disorder.
9. A psychiatrist performing electroconvulsive therapy on a patient with severe postpartum depression.
10. A provider using electroconvulsive therapy to treat a patient with severe and treatment-resistant anxiety disorder.