Healthcare Fraud Shield’s Latest Article: Coding Crisis Psychotherapy

10 Jan

What is Crisis Psychotherapy?

Crisis Psychotherapy is a session that occurs between the provider and the patient due to a life-threatening or highly complex issue that requires immediate attention.[1] According to the coding guidelines, “Psychotherapy for crisis is an urgent assessment and history of a crisis state, a mental status exam, and a disposition. The treatment includes psychotherapy, mobilization of resources to defuse the crisis and restore safety, and implementation of psychotherapeutic interventions to minimize the potential for psychological trauma. The presenting problem is typically life threatening or complex and requires immediate attention to a patient in high distress”.

How is it billed?

In 2013, the American Medical Association added two new codes[2]:

  • CPT 90839 – Psychotherapy for crisis; first 60 minutes
  • CPT 90840 – Psychotherapy for crisis; each additional 30 minutes (List separately in addition to code for primary service)

What to look for?

Be on the lookout for:

  • Excessive time billed in a given day using these codes
  • Frequency of these codes billed per patient
  • These codes should only be billed once in a given day
  • Since this service is for a patient in urgent need of care the services should not be preplanned
  • According to the American Psychiatric Association[3], this code was created due to demand from the National Association of Social Workers, but that psychiatrists will likely still use high level evaluation and management services (E/Ms) so looking for outliers of 90839-90840 vs. the series of codes found in the Psychiatry coding section (90785-90899)

As always, verify any applicable policies pertaining to coverage and reimbursement specific to your organizations. 

Healthcare Fraud Shield was already monitoring potential upcoding of these codes with the following alerts:

[2582-20] – MISREPRESENTATION OF SERVICES-CRISIS PSYCHOTHERAPY: Providers billing 90839-90840 excessively out of all psychotherapy codes compared to peers. (Peer Comparison)

[2582-30] – MISREPRESENTATION OF SERVICES-CRISIS PSYCHOTHERAPY: Providers billing 90839-90840 excessively out of all psychotherapy codes compared to peers. (Individual Tier)

If you have questions or comments you may email us at SIU@hcfraudshield.com.

REFERENCES

[1] https://www.apaservices.org/practice/reimbursement/health-codes/psychotherapy

[2] https://www.aapc.com/codes/cpt-codes/90839 , https://www.aapc.com/codes/cpt-codes/90840

[3] https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Practice-Management/Coding-Reimbursement-Medicare-Medicaid/Coding-Reimbursement/cpt-overview.pdf

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