Billing Codes for Psychiatry

Current Procedural Terminology (CPT) codes are a medical coding system created by the American Medical Association (AMA) to describe healthcare procedures, surgical procedures, diagnostic services, and more. 

In this article, we’ll describe common billing codes for psychiatry to help you find the correct code needed for billing and insurance reimbursement. 

The psychiatry billing codes that a psychiatrist can bill will depend on their clinical setting and payor. 

For example, there are different billing codes for inpatient psychiatric billing, emergency department care, consult liaison, and outpatient care. 

Within the outpatient setting, the codes you bill will depend on whether you take insurance. If you take insurance, you will have received a contract from the insurance company outlining a “fee schedule,” which contains all the eligible billing codes for psychiatry you may bill and their associated reimbursement rate. 

Let’s take a closer look at some of the most common psychiatry billing codes.

What are the different types of billing codes for psychiatry?

In general, the various types of psychiatric billing CPT codes include:

• Psychiatric diagnostic evaluation
• Psychotherapy
• Electroconvulsive therapy session
• Psychological testing
• Evaluation and management (E&M) of a new patient
• E&M of an established patient
• Initial/subsequent hospital care
• Office outpatient consult
• Initial inpatient consult
• Emergency room visit
• Nursing facility assessment (initial/subsequent)
• Domiciliary or rest home evaluation and management
• Home visit

What are E&M codes?

The term E&M stands for evaluation and management, and includes the billing code for psychiatric evaluations.

E&M codes may be used for office visits, hospital visits, home services, and preventative services. Therapy, surgery, radiology, and diagnostic tests are not considered E&M. 

E&M visits reimburse psychiatrists for the clinical interview, interpretation of signs and symptoms, formulation of a differential diagnosis, completion of a physical exam or mental status exam, the medical-decision making process, and any prescribing or ordering of tests.

What is CPT code 99214 for psychiatry?

A common psychiatry medical billing code is CPT code 99214, which is for an established patient office or other outpatient visit of 30-39 minutes.

According to  the American Psychiatric Association’s 2021 update on office/outpatient E&M billing and documentation, a 99214 CPT code could be billed according to “medical decision making” (MDM), or by time. 

The 99214 code—billed according to MDM—requires a “moderate” level of complexity, defined by:

• One or more chronic illness with exacerbation, progression or side effects of treatment.
• Two or more stable chronic illnesses.
• One undiagnosed new problem with uncertain prognosis.
• One acute illness with systemic symptoms.
• One acute complicated injury.

For example, the following situations would meet the criteria for 99214:

• Chronic major depressive disorder with inadequately controlled symptoms.
• Schizophrenia and anxiety that are well controlled.
• Chronic anxiety with upset stomach from medications.

When billing by time, the required time is 30 to 39 minutes. As of January 1, 2021, psychiatrists “may now use the total time on the date of the encounter, not just the face-to-face time.” 

This means that other activities, such as preparing to see the patient, ordering tests, and documentation, can all contribute to the 30 to 39 minutes. When billing for the psychotherapy add-on codes with an E&M code, the E&M code cannot be billed by time and must be billed by MDM. 

The psychotherapy billing add-on codes are:

• 90833: 16 to 37 minutes of therapy during the same appointment as E&M services.
• 90836: 38 to 52 minutes of therapy during the same appointment as E&M services.
• 90838: 53+ minutes of therapy during the same appointment as E&M services.

What is CPT code 99213 for psychiatry?

CPT code 99213 is for an established patient office visit of 20 to 29 minutes.

The 99213 code, billed according to MDM, requires a “low” level of complexity, defined by:

• Two or more self-limited or minor problems
• One stable chronic illness
• One acute, uncomplicated illness or injury

For example, the following situations would meet the criteria for 99213:

• Adjustment disorder and anxiety.
• Chronic major depressive disorder, in remission.
• Acute adjustment disorder with depressed mood.

When billing by time, the required time is 20 to 29 minutes. 

What are the three key components of E&M codes?

Generally, there are three key components of E&M codes included in a clinician’s documentation of the visit. 

A visit will consist of:

History taking

A clinician will ask a variety of questions to understand the course of an illness or its current status. They will then review and summarize other results or findings from other sources. The history section is typically labeled as “history of present illness” in the clinician’s notes.

Examination

Psychiatrists will perform a mental status exam with the patient. Various tools or instruments, such as a stethoscope, may or may not be used depending on the clinician’s judgment. Any results from standardized rating scales will also be included.

Medical decision making

Clinicians will include a narrative of their assessment of the patient’s history, studies, and physical exam to explain the reasoning for the treatment plan. They may also mention treatment options that were offered, or declined for other reasons. Other factors that were taken into consideration, such as cost or transportation issues, will be documented as well. The MDM section is typically called the “assessment” portion of the note. 

These three components may vary in length depending on the complexity of the patient’s presenting symptoms, the amount of data available for the clinician to interpret, or personal preference. 

Many clinicians will agree that the medical decision-making component of the note is one of the most important parts. It outlines the thought process for decision making. 

Often, there are gray areas in medicine where a non-traditional treatment approach may be chosen that needs further elaboration. 

For example, if a medication traditionally worsens a diagnosis, such as giving a selective serotonin reuptake inhibitor (SSRI) to someone with bipolar disorder, but the patient has historically done well on it, this would be explained in the MDM section. If a third-party can review your rationale for a decision or prescription, it will justify that choice as being more likely to have met the standard of care in the event of an adverse outcome. 

Other common psychiatry billing codes

Another commonly used billing code for psychiatry is CPT code 90792. This code is used for a psychiatric diagnostic evaluation with medical services and is not coded by time. 

There is also CPT code 90791, which describes a psychiatric diagnosis evaluation as well. However, the 90791 CPT code is performed by a mental health clinician, whereas 90792 is performed by a licensed medical professional, like a psychiatrist. 

The 90792 CPT code requires:

• Taking a medical and psychiatric history.
• Completion of a mental status exam.
• Formulation of an initial diagnosis.
• Determination of the patient’s ability and capacity to consent to treatment.
• Development of the plan of treatment.

For an outpatient psychiatric setting, the most common E&M codes are:

• 99213: Low medical decision making.
• 99214: Moderate medical decision making. 

Other E&M codes, such as 99215, are typically reserved for extremely acute, high-risk situations, and are therefore not common. For example, the 99215 code would be used for an individual with schizophrenia who developed akathisia, or an individual with depression with suicidal ideation and plan. Psychiatrists will agree that using a 99215 code will increase one’s risk of being audited, so be sure to use this code for only the most acute situations. 

Conclusion

While billing codes for psychiatry may seem complex at first glance, the criteria were greatly simplified in 2021. 

The requirements needed to use CPT codes 99213 and 99214 are now more straightforward. These are the most common billing codes for psychiatry, so it is easy to become familiar with them and use them correctly within your psychiatry practice management software.

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