What Is CPT Code 90833? Psychotherapy With E/M Service
Learn about CPT Code 90833, essential for billing psychotherapy sessions integrated with Evaluation and Management services.
CPT Code 90833 is used in medical billing for psychotherapy services delivered in conjunction with an evaluation and management (E/M) service. This code allows for the billing of mental health care provided during a visit that also addresses medical concerns.
Defining CPT Code 90833
CPT Code 90833 identifies psychotherapy services provided to a patient and/or their family member, when interactive complexity is a factor. This code is an “add-on” code, meaning it is not billed as a standalone service but must be paired with a primary E/M service code on the same day by the same provider.
For billing purposes, the psychotherapy session must span a minimum of 16 minutes and a maximum of 37 minutes to qualify for CPT Code 90833. Qualified providers, such as psychiatrists, psychiatric nurse practitioners, and psychiatric physician assistants, typically use this code when they offer both medical management and psychotherapy during the same session.
Understanding Interactive Complexity
Interactive complexity refers to communication factors that complicate the delivery of psychiatric procedures, such as psychotherapy, and increase the intensity of effort required by the provider. It is about how a patient’s condition or other factors complicate the therapeutic interaction. This concept is typically present when communication barriers exist that make it difficult to administer treatment effectively.
One example of interactive complexity arises when there is a need to manage maladaptive communication among participants, such as high anxiety, high reactivity, repeated questions, or disagreement, which complicates the delivery of care. Another instance is when caregiver emotions or behaviors interfere with the implementation of the treatment plan. The disclosure of a sentinel event, like abuse or neglect, which necessitates a mandated report to a third party and requires initiating a discussion of this event with the patient and other participants, also qualifies. Furthermore, the use of play equipment, physical devices, or an interpreter to overcome barriers to interaction with a patient who has not developed or lost expressive or receptive language skills, or is not fluent in the same language, signifies interactive complexity.
Billing Considerations for CPT Code 90833
When billing CPT Code 90833, accurate time tracking is essential, as the psychotherapy portion must fall within the 16 to 37-minute range. This time must be dedicated solely to psychotherapy interventions and documented separately from any E/M service time. The E/M service should be billed based on medical decision-making rather than time when paired with 90833.
CPT Code 90833 is an add-on code, meaning it cannot be billed by itself and must always be listed after an appropriate E/M code (e.g., 99202-99215). No separate modifier is typically required for 90833 itself when correctly paired with an E/M code. However, some payers may require Modifier 25 on the E/M code to indicate that it was a significant, separately identifiable service from the psychotherapy.
Essential Documentation for Reimbursement
Comprehensive and precise documentation is paramount for securing reimbursement when utilizing CPT Code 90833. The patient’s medical record must clearly justify the presence of interactive complexity, detailing the specific factors that complicated the session. This includes a narrative description or examples of the communication barriers, caregiver involvement, or emotional challenges encountered. Documentation should explain why the patient’s interaction necessitated additional effort or techniques beyond a standard psychotherapy session.
Furthermore, the documentation must explicitly state the start and end times of the psychotherapy session, ensuring it falls within the 16 to 37-minute window.
The types of therapeutic techniques or modalities used, such as cognitive behavioral therapy or supportive therapy, should also be recorded. Details regarding the patient’s progress, response to treatment, and any adjustments to the treatment plan are also necessary. Maintaining separate documentation for the E/M service and the psychotherapy portion helps demonstrate that both services were distinct and medically necessary.