How To Use CPT Code 90889

CPT 90889 describes the preparation of a report on a patient’s mental state, history, treatment, or progress for other individuals, agencies, or insurance carriers. 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 90889?

CPT 90889 can be used to describe the preparation of a report on a patient’s mental state, history, treatment, or progress for other individuals, agencies, or insurance carriers. This code is used when a provider prepares a comprehensive report that includes the patient’s psychiatric status, treatment plan, and progress made. The report is intended for entities other than for legal or consultative purposes.

2. Official Description

The official description of CPT code 90889 is: ‘Preparation of report of patient’s psychiatric status, history, treatment, or progress (other than for legal or consultative purposes) for other individuals, agencies, or insurance carriers.’

3. Procedure

1. The provider gathers information about the patient’s mental state, including their psychiatric status, history, treatment plan, and progress made.
2. A comprehensive report is prepared, including the provider’s diagnosis, prognosis, and supporting objective findings.
3. The report is tailored to the specific needs of the requesting entity, such as other physicians, agencies, or insurance carriers.
4. The report is submitted to the requesting entity for their review and use in determining coverage eligibility and ongoing case planning.

4. Qualifying circumstances

Providers eligible to use CPT 90889 are those who prepare reports on a patient’s mental state, history, treatment, or progress for other individuals, agencies, or insurance carriers. The report must be prepared for purposes other than legal or consultative services. The report typically includes the patient’s psychiatric status, treatment plan, and progress made, as well as the provider’s diagnosis, prognosis, and supporting objective findings.

5. When to use CPT code 90889

CPT code 90889 should be used when a provider prepares a report on a patient’s mental state, history, treatment, or progress for other individuals, agencies, or insurance carriers. It should not be used for reports prepared for legal or consultative purposes. This code is appropriate when the report is intended to assist other entities in determining coverage eligibility and ongoing case planning.

6. Documentation requirements

To support a claim for CPT 90889, the provider must document the following information:

• Patient’s psychiatric status, history, treatment plan, and progress made
• Specific purpose of the report and the requesting entity
• Date of report preparation
• Provider’s diagnosis, prognosis, and supporting objective findings
• Signature of the provider who prepared the report

7. Billing guidelines

When billing for CPT 90889, ensure that the report is prepared for other individuals, agencies, or insurance carriers, and not for legal or consultative purposes. It is important to accurately document the patient’s mental state, history, treatment plan, and progress made in the report. Medicare considers CPT 90889 to be an incidental service that is not separately payable, and reimbursement is bundled into the payment made for other services rendered by the provider.

8. Historical information

CPT 90889 was added to the Current Procedural Terminology system on January 1, 1990. There have been two code changes since its addition, with the most recent change occurring on January 1, 2013. The code was modified to specify that the report is prepared for other physicians, agencies, or insurance carriers.

9. Examples

1. A psychiatrist preparing a report on a patient’s mental state, treatment plan, and progress for an insurance carrier.
2. A psychologist preparing a report on a patient’s psychiatric status, history, and treatment for a requesting agency.
3. A mental health counselor preparing a report on a patient’s progress and prognosis for another physician.
4. A social worker preparing a report on a patient’s mental health history and treatment for a court-appointed guardian.
5. A psychiatric nurse practitioner preparing a report on a patient’s psychiatric status and treatment for a healthcare agency.
6. A licensed therapist preparing a report on a patient’s progress and treatment plan for an employer’s insurance carrier.
7. A clinical psychologist preparing a report on a patient’s mental state and treatment history for a disability determination agency.
8. A psychiatric nurse preparing a report on a patient’s psychiatric status and progress for a school district.
9. A behavioral health specialist preparing a report on a patient’s mental health history and treatment for a government agency.
10. A neuropsychologist preparing a report on a patient’s cognitive functioning and treatment for a research institution.