90846 – Psychotherapy Service
CPT code 90846 represents a distinct mental or behavioral health service, including evaluation, therapy, or care coordination.
What is CPT
90846
?
90846 is a specific CPT code utilized within the realm of psychotherapy services, particularly focused on individual therapy sessions. This code is essential for clinicians and billing professionals as it delineates the parameters for billing psychotherapy services that involve the participation of family members or caregivers in the therapeutic process. This entry will delve into the clinical applications of CPT code 90846, outline the necessary documentation standards that clinicians must adhere to, and discuss payer considerations that are critical for compliance. Providers must ensure that clinical notes reflect evidence-based practices and accurately document treatment goals, interventions employed, and measurable patient progress. In scenarios where the billing is time-based, it is imperative to meticulously record both the start and stop times of the sessions to substantiate the billed duration.
Documentation Tips
For billing purposes, particularly when utilizing time-based psychotherapy codes, it is crucial to document the start and stop times for each session. This includes specifying the therapeutic modality or assessment instruments used, the clinical focus of the session, the patient’s response to interventions, and a comprehensive plan for follow-up. When utilizing standardized, scored instruments, it is advisable to keep copies of these completed tools as part of the patient’s record. In instances of telehealth sessions, proper documentation of patient consent and specific platform details is necessary to meet regulatory requirements. Adopting consistent documentation structures such as SOAP (Subjective, Objective, Assessment, Plan) or DAP (Data, Assessment, Plan) can enhance audit readiness and ensure that documentation meets payer expectations.
At a Glance
- Service Type: Psychotherapy
- Use Case: Individual Therapy with Family Involvement
- Typical Setting: Outpatient clinic or telehealth (subject to specific payer policies)
- Billing Unit: Per session / per instrument (varies depending on specific coding guidelines)
- Common Pairings: 90791 (Psychiatric Diagnostic Evaluation), 96127 (Brief emotional/behavioral assessment), other psychotherapy codes
Billing Examples
For instance, a clinician may conduct a focused therapy session employing Cognitive Behavioral Therapy (CBT) techniques to address a patient’s panic symptoms. During this session, the clinician meticulously documents the interventions used, such as cognitive restructuring and exposure exercises, and tracks the patient’s progress toward established treatment goals. If the session lasts for 45 minutes, the clinician should bill using the appropriate time-based psychotherapy code that accurately reflects the actual face-to-face time spent with the patient. In another scenario, a therapist might engage in a session with a patient alongside their family members, utilizing the 90846 code to bill for the inclusion of family dynamics in the therapeutic process, ensuring that all relevant interactions and outcomes are recorded.
Compliance Guidelines
- Confirm payer coverage and authorization requirements before submitting claims to avoid delays and denials.
- Thoroughly document medical necessity, linking all services rendered to appropriate ICD-10 diagnoses to substantiate the need for therapy.
- Utilize correct modifiers as necessary (e.g., modifier 95 for telehealth services) to ensure compliance with payer regulations.
- Avoid upcoding; always select the code that accurately reflects the documented time and level of service provided.
- Conduct regular audits of billing practices and documentation quality to minimize claim denials and enhance compliance readiness.
Common ICD-10 Codes
Helpful links for mental health billing and documentation
- F32.0 (Major depressive disorder, single episode, mild)
- F41.1 (Generalized anxiety disorder)
- F33.1 (Major depressive disorder, recurrent, moderate)
- F43.10 (Post-traumatic stress disorder, unspecified)
- F41.9 (Anxiety disorder, unspecified)
- F34.1 (Dysthymic disorder)
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 clinical purpose of CPT code 90846?
A: CPT code 90846 is designated for psychotherapy services involving individual therapy sessions where family members may contribute to the therapeutic process. Proper documentation must align with the code’s definition to support the billing.
Q2: Is it permissible to bill CPT code 90846 for telehealth sessions?
A: Yes, many payers allow billing for telehealth services when the session is conducted synchronously, provided proper modifiers and patient consent are documented. Always check individual payer policies for specific requirements.
Q3: What types of documentation might payers request for reimbursement?
A: Payers typically request detailed documentation including the duration of the session, therapeutic techniques or instruments utilized, patient responses, and a clear linkage to a covered ICD-10 diagnosis.
Q4: Can CPT code 90846 be billed in conjunction with other services?
A: Yes, when billing multiple services, it is essential to document distinct time spent on each service and provide a rationale for each. Utilize add-on codes or adhere to Evaluation and Management (E/M) separation rules as applicable.
Q5: What are some common reasons for claim denials related to CPT code 90846?
A: Common denial reasons include insufficient documentation of time spent, failure to demonstrate medical necessity, incorrect use of modifiers, or billing beyond established frequency limits set by payers.
