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THE NEW CPT CODES:WHAT THEY ARE

AND HOW TO USE THEM

CPT copyright 2012. American Medical Association.All rights reserved. CPT is a registered trademark of the American

Medical Association.

Crosswalk of Most Frequently Used CPT Codes

2012 CODE 2013 CODE ADDITIONAL INFORMATION

ADD-ON CODE(For Interactive

Complexity)

90801 90791 Diagnostic Evaluation

90804 90832 (30 min) Actually 16-37 min 90785 (when appropriate)


90847 No Change Family Therapy Conjoint, With Patient

90853 No Change Group Therapy (other than multiple-family group)

Basic Differences & Changes•Some codes have simply been changed•For example, what was 90801, initial evaluation, is now 90791

•Some codes have not changed•For example, family therapy with the patient, 90847, remains unchanged

Basic Differences & Changes•2012 codes which have changed

•Psychotherapy codes based on amount of time spent in interview

•Initial diagnostic evaluation codes•Interactive codes

Basic Differences & Changes•Modifier (“add-on codes”)

• Indicates increased interactive complexity of the intervention

•Used ONLY in conjunction with a primary code for evaluation, psychotherapy, or group therapy

•Never used as stand-alone codes

Interactive Complexity•CPT Manual has specific guidelines•Examples include:

• Play therapy with young children• Managing maladaptive communications or interactions between patient and family

• Discussing an event that requires a mandated report

Interactive Therapy•There is no longer a separate code for interactive therapy

•Now indicated by the add-on code (90785) for interactive complexity

New Codes for Crisis Intervention• Involve situations which require immediate intervention and include• Urgent assessment• History of the crisis state• Mental status exam• Disposition (mobilization of resources, interventions to minimize crisis and restore safety)

No Site-of-Service Differential•There is NO differentiation based on setting• i.e. WHERE a service takes place• In-office codes are the SAME as inpatient codes for the SAME service

No Grace Period•Use of new codes is based on Date of Service (DOS), NOT on date of submission of claim• All DOS before 1/1/13 must us OLD CPT codes

• All DOS after 1/1/13 must use NEW CPT codes

• Continue to follow ALL filing/billing rules for each insurance company

Crosswalk of 2013 CPT Codes2012 CODE 2013 CODE ADDITIONAL

INFORMATIONADD-ON CODE(For Interactive

Complexity)

90801 90791 Diagnostic Evaluation

90802 90791 Interactive Diagnostic Evaluation

90785

Diagnostic Evaluation• There is only one code to be used for evaluation: 90791

• To indicate interactive diagnostic evaluation, use 90791 and add-on code 90785

• Diagnostic evaluation code can be billed more than once:• When conducted on separate days• When separate evaluations are conducted with patient and other informants

Interactive Complexity• Play therapy with young children• Use of translator or interpreter

• Medicare will not pay for this• To manage maladaptive communication that complicates delivery of care

• When the patient’s family behavior interferes with treatment plan

• When one must discuss a sentinel event that requires a mandated report



Complexity)



90808 90837 (60 min) Actually 53+ min 90785 (when appropriate)

Psychotherapy• Use the shorter code, now 90832, for half sessions

• Use intermediate code, 90834, for regular 45-50 minute sessions

• Thus, 90834 will be our new STANDARD “50 minute hour”

• 90806 was for “individual therapy”• 90834 is now for “psychotherapy with patient and/or family member”

Psychotherapy• Few MCOs have actually paid in the past for 90808• Therefore do not bill 90837

• Bill the Crisis Code if it is a crisis• 90839 (60 min.) and 90840 (each additional 30 min.)

• If patient is in crisis and it is clinically indicated to extend the session

• AND work fits the criteria for crisis



Complexity)

90810 (interactive)

90832 (30 min) Actually 16-37 min 90785

90812 (interactive)

90834 (45 min) Actually 38-52 min 90785

90814 (interactive)

90837 (60 min) Actually 53+ min 90785



Complexity)

90816 (inpatient)

90832 (30 min) Actually 16-37 min 90785 (when appropriate)

90818 (inpatient)

90834 (45 min) Actually 38-52 min 90785 (when appropriate)

90821 (inpatient)

90837 (60 min) Actually 53+ min 90785 (when appropriate)

Inpatient & Facilities•Services provided in a facility NO LONGER have a separate code

•Facility refers to inpatient psychiatric unit, partial hospitalization program, residential facility



Complexity)

No Existing Code

90839 Psychotherapy for Crisis –60 min (actually 30-74 min)

No existing Code

90839 Psychotherapy for Crisis –each additional 30 min

90840

• A crisis involves a situation which requires immediate attention for a life threatening situation, and includes:• Urgent Assessment• History of crisis• Mental status exam• Disposition (mobilization of resources, interventions to diffuse

crisis, restore safety and minimize psychological trauma)



Complexity)

90857 90853 (with add-on)

Interactive Group Therapy 90785



Complexity)90845 No Change Psychoanalysis

90846 No Change Family Therapy Without Patient

90847 No Change Family Therapy Conjoint, With Patient

90849 No Change Multiple-family Group Psychotherapy

90853 No Change Group Therapy (other than multiple-family group)

90880 No Change Hypnotherapy

90889 No Change Preparation of report of patient’s psychiatric status, history, treatment, or progress (other than for legal or consultative purposes) for other therapists, physicians, or insurance carriers

Medicare Payment for Conjoint Family Therapy

• Medicare will pay for conjoint marital or family therapy ONLY when primary purpose is treatment of patient’s condition• To observe patient’s interaction with family members

• To assess the capability of, and assist family members in aiding in, management of patient

90889: Preparation of a Report• Insurance carriers will NOT cover this code!

1500 Health Insurance Claim Form

Preliminary Rates•Not determined yet• Probably:

• 90791 (evaluation) will pay same as 90801

• 90834 (38 – 52 minutes; “50 minute hour”) will be the same as 90806

• Each insurance company will determine rates for 90839 & 90840

Authorizations• Magellan states new code will require authorization if it was mapped from an old code that required one. Auths already in place will cross over into 2013

• New crisis codes will require authorization, probably by phone (not on-line)

• Not yet determined if new add-on code will need authorization

the new cpt codes - c.ymcdn.com · •medicare will pay for conjoint marital or family therapy only...

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