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Crosswalk of Psychotherapy Codes for Clinical Social Workers

The following article was originally published in the November 2012 Fall issue of the National NASW Practice Perspectives newsletter.

New Psychotherapy Codes for Clinical Social Workers

OLD CODES NEW CODES as of 2013
90801 90791
90802 90791 + 90785 (add-on)
90804 90832
90806 90834
90808 90837
90810 90832 + 90785 (add-on)
90812 90834 + 90785 (add-on)
90814 90837 + 90785 (add-on)
90816 90832
90818 90834
90821 90837
90823 90832 +90785 (add-on)
90826 90834 + 90785 (add-on)
90828 90837 + 90785 (add-on)
No Code 90839
No Code 90840
90845 No Change
90846 No Change
90847 No Change
90849 No Change
90853 No Change
90857 90853 + 90785 (add-on)
90880 No Change
90889 No Change

Effective January 2013, clinical social workers will begin using new and revised psychotherapy codes when providing psychotherapy services to patients. For the first time since 1998, the family of psychotherapy codes has gone through a major revision process. NASW provided national social work leadership in the development and approval processes for the new and revised psychotherapy codes through the American Medical Association Current Procedural Terminology (CPT) Editorial Panel. In addition to working with CPT panel, NASW also worked collaboratively with the American Psychiatric Association, Academy of Child and Adolescent Psychiatry, American Nurses Association, and American Psychological Association.

In 2011, NASW members were first introduced to the new codes when they participated in a national psychotherapy survey sponsored by the American Medical Association and the Centers for Medicare and Medicaid Services to determine work values for the new and revised psychotherapy codes. Work values consist of how much time, mental effort, skills, judgment, and stress it takes to perform a psychotherapy service.

The new and revised codes better reflect psychotherapy services delivered in the 21st century. Some of the codes remain the same such as family therapy, psychoanalysis, and hypnotherapy. Definitions of psychotherapy services have also been revised and two new services are introduced: psychotherapy for crisis and interactive complexity.

New and Revised Definitions of Services

In addition to new psychotherapy codes, there are new and revised definitions of psychotherapy services.

  • PSYCHIATRIC DIAGNOSTIC EVALUATION. An integrated bio-psychosocial assessment, including history, mental status, and recommendations.

  • PSYCHOTHERAPY. The treatment of mental illness and behavioral disturbances in which the physician or other qualified health care professional, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development.

  • INTERACTIVE COMPLEXITY. Specific communication factors that complicate the delivery of a psychiatric procedure. Common factors include more difficult communications with discordant or emotional family members and engagement of young and verbally undeveloped or impaired patients. Typical patients are those who have third parties, such as parents, guardians, other family members, interpreters, language translators, agencies, court officers, or schools involved in their psychiatric care.

  • PSYCHOTHERAPY FOR CRISIS. An urgent assessment and history of a crisis state, a mental status exam, and a disposition.

CPT copyright 2012. American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Deleted Codes

The following codes have been deleted as of 2013.

90801 - Psychiatric diagnostic interview examination.

90802 - Interactive psychiatric diagnostic interview using play equipment, physical devices, language interpreter, or other mechanisms of communication.

90804 - Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient.

90806 - Individual psychotherapy, insight oriented, behavior modifying and/or supportive in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient.

90808 - Individual psychotherapy, insight oriented, behavior modifying and/or supportive in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient.

90810 - Individual psychotherapy, interactive, physical devices, language interpreter, or other mechanisms of nonverbal communication in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient.

90812 - Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of nonverbal communication in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient.

90814 - Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of nonverbal communication in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient.

90816 - Individual psychotherapy, insight-oriented, behavior modifying and/or support, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face-to-face with the patient.

90818 - Individual psychotherapy, insight-oriented, behavior modifying and/or support, in an inpatient hospital, partial hospital or residential care setting, approximately 45 to 50 minutes face-to-face with the patient.

90821 - Individual psychotherapy, insight oriented, behavior modifying and/or supportive in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient.

90823 - Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of nonverbal communication in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face-to-face with the patient.

90826 - Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of nonverbal communication in an inpatient hospital, partial hospital, residential care setting, approximately 45 to 50 minutes face-t-face with patient.

90828 - Individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanism of nonverbal communication in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient.

90857 - Interactive group psychotherapy.

Codes Without Changes In Numbers or Descriptors

The following codes remain without changes in code numbers and descriptors. There were changes in the vignettes which describe the services. Vignettes are used in psychotherapy surveys to describe the patient’s symptoms which are used to determine the work to be performed.

90845 - Psychoanalysis.

90846 - Family psychotherapy (without the patient present).

90847 - Family psychotherapy (conjoint psychotherapy, with the patient present).

90849 - Multiple-family group psychotherapy.

90853 - Group psychotherapy (other than of a multiple-family group).

90880 - Hypnotherapy.

90889 - Preparation of report of patient’s psychiatric status, history, treatment, or progress (other than for legal or consultative purposes) for other physicians, agencies, or insurance carriers.

New Codes for Individual Psychotherapy

Several new codes have been developed and some codes replace those formerly used for former individual psychotherapy services. The codes are for face-to-face services and include all settings such as outpatient office, inpatient hospital or partial hospitalization, residential care, and assisted living facility. The psychotherapy session can be with a patient and/or family member.

90791 - Psychiatric Diagnostic Interview.

90832 - Psychotherapy, 30 minutes with patient and/or family member.

90834 - Psychotherapy, 45 minutes with patient and/or family member.

90837 - Psychotherapy, 60 minutes with patient and/or family member.

Additional New Codes

90785 - Interactive complexity (Use only as an add-on code with the following new and existing psychotherapy codes: 90791, 90832, 90834, 90837, and 90853).

90839 - Psychotherapy for crisis; first 60 minutes.

90840 - Psychotherapy for crisis; each additional 30 minutes.

For 2013, only the family of psychotherapy codes has been revised. There are no changes in the Health and Behavior Assessment and Intervention Codes or the Team Conference Codes used by clinical social workers. A crosswalk of the new and revised psychotherapy codes related to clinical social workers is located at the end of this document.

Clinical social workers who use deleted psychotherapy codes in 2013 will receive claim denials resulting in non-payment of psychotherapy services. NASW continues to advocate for clinical social workers in the coding process through the American Medical Association CPT Editorial Panel and will inform its members of any additional changes.

Resources

  • American Medical Association. 2012. CPT 13, Professional edition. Chicago, IL: Author.
  • American Medical Association. 2011. CPT 12, Professional edition. Chicago, IL: Author.
  • U.S. Department of Health and Human Services. November 1, 2012. 42 CFR Parts 410, 414, 415, 421, 423, 425, 486, 495. Government Printing Office. Washington, DC.

The information above was originally published in the January 2013 FOCUS newsletter.
Author: Mirean Coleman, LICSW, CT; Senior Practice Associate, National NASW.

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1/1/2013

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