2013 CPT Billing Code Changes for Psychiatry

Code Changes Explained: Psychiatry Section of AMA's 2013 CPT Manual
Code Changes Explained: Psychiatry Section of AMA's 2013 CPT Manual

Effective January 1, 2013, major changes have been enacted to the codes in the Psychiatry section of the American Medical Association's (AMA) manual on Current Procedural Terminology (CPT), 4th Edition.1

The CPT coding system was created to provide a uniform language for describing medical and surgical procedures and diagnostic services to facilitate effective communication between clinicians, third-party payers, and patients. Evaluation and management (E/M) codes cover a family of general medical services provided in various settings, ie, office, hospital, nursing home, emergency department, etc.2

1)  A distinction has been made between an initial evaluation with medical services done by a physician (90792) and an initial evaluation done by a non-physician (90791).

2)  Psychotherapy codes have been simplified and expanded to include time with both the patient and/or family member:

  • 30 minutes (90832)
  • 45 minute (90834)
  • 60 minutes (90837)

If psychotherapy is provided at the same time as E/M services, the following timed add-on codes are to be used indicated by the (+) symbol:

  • 30 minutes (+90833)
  • 45 minutes (+90836)
  • 60 minutes (+90838)

AMA CPT

“Time Rule”: Time is only the time spent face-to-face with the patient and/or family member. If the actual time is more than half the code time, then that code can be used. For example, for 16–37 minutes use the 30-minute code; for 38–52 minutes use the 45-minute code; for >53 minutes use the 60-minute code.1

3)  In place of the separate interactive psychotherapy codes, an add-on code for interactive complexity “+90785” may be used when the patient encounter is made more complex by the need to involve people other than the patient.  This system complexity add-on code can be used with:

  • Initial evaluation codes (90791 and 90792)
  • Psychotherapy codes
  • Non-family group psychotherapy code (90853)
  • E/M codes in conjunction with psychotherapy services