90838 – Psychotherapy Service
CPT code 90838 represents a distinct mental or behavioral health service, including evaluation, therapy, or care coordination.
What is CPT
90838
?
90838 is a CPT code designated for use in individual psychotherapy sessions, particularly when the therapy session lasts longer than 60 minutes. This entry will delve into the clinical application of this code, the expectations regarding documentation, and relevant payer considerations. It is essential for healthcare providers to ensure that their clinical notes accurately reflect the evidence-based interventions utilized during therapy. Additionally, documentation should detail specific treatment goals, the interventions employed, and any measurable progress observed. When billing for time-based services, it is crucial to record precise start and stop times to substantiate the billed duration, aiding in compliance and reimbursement.
Documentation Tips
When billing for time-based psychotherapy, it is imperative to document the exact start and stop times of the session. Providers should also include the therapeutic modality employed (e.g., Cognitive Behavioral Therapy, Dialectical Behavior Therapy), the assessment instruments utilized, the clinical focus of the session, patient responses, and a clear plan for follow-up sessions. For any scored instruments used, practitioners must retain copies of the completed tools for reference. In cases of telehealth, it is essential to document patient consent and the details of the platform used during the session. To ensure audit readiness, maintain consistency in using established documentation frameworks such as SOAP (Subjective, Objective, Assessment, Plan) or DAP (Data, Assessment, Plan).
At a Glance
- Service Type: Psychotherapy
- Use Case: Individual Therapy
- Typical Setting: Outpatient clinic or telehealth (subject to payer policy)
- Billing Unit: Per session / per instrument (varies by code)
- Common Pairings: 90791, 96127, and other psychotherapy codes
Billing Examples
For instance, a clinician may conduct a focused therapy session using Cognitive Behavioral Therapy (CBT) techniques to help a patient manage anxiety and panic symptoms. During the session, the clinician documents specific interventions, such as cognitive restructuring and exposure tasks, while also noting the patient’s progress toward established treatment goals. If the session lasts 75 minutes, the clinician should bill using the appropriate time-based psychotherapy code that accurately reflects this duration. Another example could involve a clinician conducting a session lasting 90 minutes, focusing on trauma processing techniques. The clinician should document the therapeutic interventions employed, patient engagement levels, and any notable changes in symptoms, ensuring that billing reflects the actual time spent with the patient.
Compliance Guidelines
- Prior to billing, verify the payer coverage and authorization requirements specific to the services rendered.
- Document medical necessity thoroughly, ensuring that all services provided are directly linked to corresponding ICD-10 diagnoses.
- Utilize appropriate modifiers when necessary (e.g., 95 for telehealth services) to comply with payer requirements.
- Avoid upcoding practices; select the code that accurately corresponds to the documented service duration and complexity.
- Conduct regular audits of billing practices to minimize denial rates and improve the overall quality of documentation.
Common ICD-10 Codes
Helpful links for mental health billing and documentation
- F32.0
- F41.1
- F33.1
- F43.10
- F41.9
- F34.1
Additional Resources
Helpful links for mental health billing and documentation
Related CPT Codes
Helpful links for mental health billing and documentation
Got questions? We’ve got answers.
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Q1: What is the purpose of this code?
A: The CPT code 90838 is utilized when the clinical activity aligns with the specific definition of the code. It is crucial to ensure that all documentation supports the service billed, reflecting the therapist’s clinical rationale.
Q2: Is it permissible to bill this code for telehealth services?
A: Yes, many payers cover telehealth services for synchronous sessions, provided that the necessary modifiers and patient consent are appropriately documented. Always verify payer policies for telehealth coverage.
Q3: What type of documentation might payers request for this code?
A: Payers typically request documentation that includes the time spent in the session, the therapeutic techniques or assessment instruments utilized, patient responses to treatment, and a clear linkage to a covered ICD-10 diagnosis.
Q4: Can this code be billed in conjunction with other services?
A: Yes, when billing multiple services, it is essential to document distinct time allocations and clinical rationale for each service provided. Utilize add-on codes or follow Evaluation and Management (E/M) separation rules as applicable.
Q5: What are some common reasons for claim denials associated with this code?
A: Common denial reasons include missing documentation of session times, insufficient evidence of medical necessity, incorrect use of modifiers, or billing beyond allowed frequency limits as per payer guidelines.
