Counseling CPT codes for private practitioners

Introduction

Navigating Current Procedural Terminology (CPT) codes is a crucial yet complex aspect of healthcare. The wealth of information involved can make mastering these codes overwhelming. To simplify the process, we've researched the most commonly used CPT codes in counseling and provided tips to optimize your coding practices. Let's dive in!

Overview on CPT® codes

CPT codes are vital for documenting medical procedures and ensuring reimbursement for medical services. This current procedural terminology system uses standardized alphanumeric codes to represent specific treatments or services performed during patient interactions. These codes are used by federal programs like Medicare, Medicaid, and private insurers to standardize healthcare documentation and streamline the billing process.

The American Medical Association (AMA) reviews and updates CPT codes annually, making it challenging for mental health practitioners to stay up-to-date. Having a solid understanding of mental health CPT codes, particularly those relevant to your field—such as counseling, psychiatry, or therapy—is key to maintaining coding accuracy.

Why are CPT codes essential for private practitioners?

Accurate CPT coding is critical when submitting insurance claims for reimbursement. After a patient receives treatment, the correct CPT codes must be used to document the specific medical procedures and medical services provided. These claims are then reviewed by the insurance provider, and only accurate submissions lead to reimbursement.

A healthcare practice’s financial stability and reputation depend heavily on precise claims submission, which hinges on using the correct CPT codes. Understanding industry-specific evaluation and management services codes helps practitioners avoid costly errors and delays in payments. A deeper understanding of the coding process and evaluation and management services will further enhance your practice's efficiency.

Most common Counseling CPT Codes for Private Practitioners

Now, let's take a look at some of the most commonly used CPT codes by mental health professionals. Knowing these codes will systematize and organize the coding process at your healthcare practice. It can also be useful to have an understanding of different healthcare field codes as well, for example, CPT codes for family therapy billing and CPT codes for occupational therapy evaluation. This information will make your coding process much easier, especially when you take into consideration how interrelated healthcare services can be. The following outline the most common counseling CPT codes:

Diagnostics

• 90791 (Psychiatric diagnostic evaluation): Used for an initial mental status exam where no medical services are provided.
• 90792 (Psychiatric diagnostic evaluation with medical services): This code includes a diagnostic evaluation plus medical services like prescribing medication.

Therapy

• 90832 (30-min psychotherapy): Used for shorter individual therapy sessions lasting 30 minutes, with between 16 and 37 minutes of documented face-to-face time.
• 90834 (45-min psychotherapy): Applied to standard individual therapy sessions lasting 45 minutes.
• 90837 (Psychotherapy, 1): Used for longer, more comprehensive therapy sessions lasting 60 minutes.
• 90846 (Family or couples therapy, without the patient present, 50 minutes): Used for family therapy sessions where the primary patient is not present.
• 90847 (Family or couples therapy, with the patient present, 50 minutes): Applies when the primary patient is present during the session.
• 90853: (Group psychotherapy (other than of a multiple-family group): Used for therapy in a group setting.
• 98968 (Telephone assessment and management service provided by a qualified non-physician health care professional to an established client, parent or guardian, 21-30 minutes): Used for remote therapy sessions delivered via telehealth.
• 90839 (Psychotherapy for crisis, 60 minutes): This crisis code is for emergency therapy sessions dealing with acute psychological distress.

Assessments

• 96105 (Assessment of aphasia): Applied for tests to evaluate language impairment in individuals with aphasia.
• 96125 (Standardized cognitive performance testing, per hour): This code is for standardized tests that assess cognitive abilities.
• 96110 (Developmental screening and testing): Used to assess a child's developmental milestones.
• 96112 (Developmental test administration): For in-depth developmental testing beyond basic screening.
• 96127 (Brief emotional/behavioral assessment): Used for short evaluations of emotional or behavioral health issues.

Psychological testing

• 96116 (Neurobehavioral status exam, first hour): Used for assessing cognitive function and behavior through structured testing.
• 96130 (Psychological testing evaluation by a physician, first hour): Used for the first hour of in-depth psychological evaluation.

If you're reading this list and feeling somewhat overwhelmed, that's totally okay. There are quite a large number of different CPT codes and it can be difficult to remember the specific codes relevant to your work. It is important to note, however, that most common CPT codes change rarely, so as soon as you have a good understanding of how they apply to your services, the coding process will be much easier!

Add-on CPT codes for mental health billing

In addition to the top CPT codes for mental health services, there is a range of add-on codes. These CPT codes must be used in conjunction with other relevant codes, and help to explain specific details of a session or demonstrate complexities. Add-on codes can be specific to different primary codes – for example, there are add-on codes applicable to CPT code set for psychological testing and evaluation codes that may differ from those applicable to diagnostic CPT codes.

Here are some of the most commonly used add-on CPT codes for mental health billing:

• 90785 (Interactive complexity code): Indicates that the session involved additional complexity, such as communication difficulties.
• 90863 (Pharmacological management): Used when medication management is provided during a therapy session.
• 99050 (Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed): For sessions provided outside of typical office hours such as weekends or holidays.
• 90840 (Psychotherapy for crisis; each additional 30 minutes): For extending a crisis therapy session by an additional 30 minutes.
• 90833 (Additional 30 minutes of psychotherapy): Used for adding extra time to a therapy session when necessary.

Final thoughts

While medical coding can be quite complex, this guide has highlighted key CPT codes relevant to the healthcare industry. Mastering CPT codes is essential, but it’s only the first step. Having a solid understanding of ICD codes and recognizing the differences between common CPT codes, and HCPCS is also crucial. Armed with this knowledge, you’ll become an expert in patient care coding in no time.

Another key aspect to improve your medical coding process is to invest in practice management software. These systems integrate advanced tools for data collection and help organize CPT code sets, ensuring that claims for services provided are accurate and submitted correctly. For example, software like Carepatron can streamline the coding of psychological testing, multiple family group therapy, and other specific services, making it easier for healthcare providers to get paid quickly and correctly.

Carepatron is designed to optimize the billing and coding process for all health care professionals, ensuring accuracy in the claims process, whether you’re coding for primary procedures, add-on services, or using CPT code sets. This customer-focused health care solution aims to accelerate reimbursement rates while improving accuracy. To learn more about how Carepatron can benefit your practice, get in touch and explore our free solution today.

Further Reading:

• Psychotherapy Codes for Psychologists 101
• New CPT Codes for Behavioral Health Services