90838 CPT Code: Psychotherapy, 60 minutes, patient & family.

What is CPT Code 90838

CPT Code 90838 refers to a psychotherapy session that involves an extended duration, typically indicating that it lasts 60 minutes or more. This code falls under the category of psychotherapy for individuals who may have more complex mental health needs that necessitate additional time. The code is particularly relevant in situations where patients require a deeper therapeutic engagement, as might be the case in chronic mental health issues or complex diagnoses.

This code is specifically designated for the reporting of psychotherapy sessions done by qualified mental health professionals. The session must involve distinct therapeutic techniques aimed at addressing the mental health issues presented by the patient. Proper documentation must support the use of this code to ensure that the therapy provided aligns with the criteria established by insurance providers for reimbursement.

Services Covered Under CPT Code 90838

CPT Code 90838 encompasses a variety of psychotherapy services designed to address complex mental health situations. The below table details the services covered under this specific code.

Who Can Use the 90838 CPT Code?

This code can be utilized by various licensed mental health professionals, ensuring that the services provided during the therapy sessions are consistent with high standards. The following licensed professionals are typically qualified to use CPT Code 90838:

• Psychologists: They can conduct thorough assessments and provide comprehensive therapy services.
• Licensed Clinical Social Workers (LCSWs): Equipped to provide psychotherapy and interventions in mental health.
• Licensed Professional Counselors (LPCs): Specialists in individual and group therapy sessions addressing mental health issues.
• Pediatric Mental Health Specialists: Professionals working specifically with children and adolescents can also appropriately use this code when relevant.

How to Use CPT Code 90838

Properly employing CPT Code 90838 involves adhering to specific guidelines to ensure accuracy and compliance with billing standards.

• Document session start and end times accurately to confirm the duration.
• Detail the therapeutic techniques utilized to provide a clear rationale for the extended session.
• Provide a narrative summary of the session that links therapeutic interventions to patient progress.
• Ensure that the patient’s treatment plan reflects the complexity of their condition to justify the use of this code.

Reimbursement Rates for CPT Code 90838

Disclaimer: Reimbursement rates can fluctuate and are subject to change based on various factors, including geographical location and individual insurance policies. The rates listed are average estimates, and this article is kept up to date with the latest information.

Benefits of CPT Code 90838

This code offers several advantages that elevate the quality of mental health services provided to patients. Below is a table outlining the benefits associated with CPT Code 90838.

Common Mistakes to Avoid with CPT Code 90838

CPT Code 90838 is utilized for extended psychotherapy sessions. Misuse of this code can lead to serious consequences such as audits or claim denials.

• Incorrect Session Duration: Some practitioners may incorrectly document session lengths, leading to compliance issues. An example includes billing for a typical 45-minute session as 60 minutes.
• Lack of Detailed Documentation: Failing to adequately document the therapeutic techniques used can result in questions regarding the session's necessity. For instance, not specifying the CBT methods employed during a session can lead to challenges during audits.
• Billing for a Non-Complex Case: Using this code for patients with less complex needs can trigger denials. Providers mistakenly coding this for a routine follow-up is a common oversight.
• Missing Treatment Plans: Not having a documented treatment plan that justifies extended therapy can lead to reimbursement issues. For instance, using the code without an updated plan reflecting ongoing complexities would be improper.

CPT Code 90838 vs other codes

When comparing CPT Code 90838 to other psychotherapy codes, it is essential to observe how they cater to different aspects of therapeutic practice. Below is a comparison of this code with similar codes.

Conclusion

Understanding and adhering to the guidelines surrounding CPT Code 90838 is vital for mental health professionals looking to provide extended psychotherapy services. By ensuring accurate documentation, thorough understanding of the services offered, and remaining compliant with billing practices, practitioners can deliver optimal care while maintaining financial sustainability. Continuous awareness of code requirements and reimbursement policies will bolster the effectiveness and reliability of mental health service delivery.

Disclaimer: This article is for informational purposes only and does not constitute legal or medical advice. Always consult professional guidelines and regulatory bodies for specific compliance requirements.