Q: Why doesn't my patient's insurance company pay for all the procedures listed in the CPT Handbook?
A: CPT is a coding system that is applicable to services provided under Medicare coverage. Insurance companies and other third-party payers are not obligated to accept CPT codes to describe treatment, nor are they obligated to pay for services described in the CPT Handbook. In fact, some insurance contracts specifically exclude certain CPT codes, for example, 90846 and 90847, which describe family psychotherapy. The Academy approved a Policy Statement on Family Psychotherapy for members to use to convince third-party payers to reimburse for this important service.
Q: The codes keep changing! How can I be sure I'm using the right codes?
A: Each year the AMA publishes an updated CPT handbook and child and adolescent psychiatrists are encouraged to be sure to use the most recent edition (AMA Publications Catalog, 1-800-621-8335; http://www.ama-assn.org). The handbook includes changes in codes and coding procedures instituted by HCFA during the previous year. The AMA also operates a CPT Information Service, which for a fee will answer specific coding questions (1-800-262-4336).
The Academy's CPT Training Module, also updated yearly, describes changes to the codes and coding procedures frequently used in child and adolescent psychiatry. During the year, updates on coding are published in the AACAP News and on this page (CPT Codes Changes & Updates).
Q: Should I be using codes 90842, 90843, 90844, and 90855 for the psychotherapy services I provide?
A: To obtain reimbursement for services billed to a Medicare carrier, as of January 1, 1998 a numerical series of codes replaces codes 90804 - 90829. These numerical codes are in a series 90804-90829.
To obtain reimbursement from any other insurer, the answer depends on the policy of that particular carrier. It is best to contact the insurer directly for information on which codes to use. For example, an insurer may honor codes 90842, 90843, 90844, and 90855, or may require that the 1998 codes (90804 - 90829) be used instead.
Q: Which codes should I use if I see a patient for medication monitoring, reviewing test results, or coordinating medical care?
A: It depends. These procedures are considered medical evaluation and management (E/M) and therefore, the answer depends on whether psychotherapy was also provided to that patient on that day. If psychotherapy was also provided, then one of the new codes (90804 - 90829) that includes E/M services should be used. If psychotherapy was not provided, then an E/M code (such as the 99XXX series), 90802, 90845, or 90801 may be the most appropriate code.
Q: I saw a patient for 35 minutes, providing psychotherapy with medication management and a brief health status update mixed in. The patient's insurance company says that I should use code 90805, which covers only 20-30 minutes. What's going on?
A: Code 90805 describes outpatient psychotherapy (insight oriented, behavior modifying and/or supportive) for 20-30 minutes with E/M. The time frame defined in the code applies ONLY to the psychotherapy portion of the visit. It doesn't matter how much time is spent on E/M in a given day-- 5 minutes or 5 hours! If psychotherapy was provided for 20-30 minutes, then 90805 is the correct code.
The best procedure is to keep psychotherapy and E/M clearly separate within a visit. For example, a child and adolescent psychiatrist could perform medication monitoring either right before or right after the psychotherapy portion of the face-to-face visit, and then select the CPT code based on the amount of time spent providing psychotherapy during that visit.
Q: Which CPT code should I use if I split a single psychotherapy session between seeing a child alone and seeing the parents alone?
A: If the parents were seen for child-related content (i.e., inclusive of information about the child's condition or treatment, and exclusive of marital or other concerns) then the entire visit can be coded as face-to-face psychotherapy with the child.
1-800-252-4336 American Medical Association CPT Information Services
1-800-333-7636 American Academy of Child & Adolescent Psychiatry Managed Care Complaint Service of the Clinical Affairs Department
Click here for the CPT Codes.
57th Annual Meeting
October 26-31, 2010
New York, NY
Hilton New York
Call for Papers
The submission deadline for AACAP's Annual Meeting Call for Papers is Tuesday, February 16, 2010 or Tuesday, June 15, 2010 for late New Research Posters. All submissions must be made online. Click here for complete details and to start a submission.
The Annual Meeting Preliminary Schedule will be available online on June 15, 2010. The Registration Magazine with full program details will be mailed to all members in August. If you would like to be added to this mailing list, please contact Nelson Tejada at email@example.com.
Registration for the Annual Meeting will open in August.
The host hotels for AACAP's 57th Annual Meeting are the Hilton New York and Sheraton New York Hotel and Towers. The room block is not open to make reservations for the Annual Meeting and rates have not been confirmed. Check back in February for more information.
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If so, serve as a MONITOR for one full day to receive free registration for the 57th Annual Meeting of the American Academy of Child and Adolescent Psychiatry. Check back on this site in May to sign up to be a Monitor.
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