In Brief
Sometimes the care you provide isn’t straightforward – some services may involve difficulties that take more effort and more time. With already high demands on a therapist’s schedule, time is valuable, and you deserve to be compensated for that time. That’s where add-on codes come in.
There are plenty of nuances and complexities when it comes to using CPT codes, and add-on codes like 90785 are no exception. Let’s take a closer look at CPT code 90785, covering: its definition, usage, billing criteria, reimbursement strategies, and limitations.
What is the CPT Code 90785?
CPT code 90785 serves as an add-on code to indicate interactive complexity in psychotherapy sessions. It works alongside other psychotherapy codes when a client’s condition requires additional time and expertise from the therapist providing treatment. Practically, this means that it’s used to give the therapist a bit of extra reimbursement when there are certain types of communication difficulties (more on that shortly) during client sessions.
When to Use CPT Code 90785
You can apply CPT code 90785 alongside other psychotherapy codes when your session includes interactive complexity. This code fits various situations, such as:
- Communication difficulties: Use this when you face barriers to communication due to low intellectual functioning or speech or hearing impairments, which complicate the care process.
- Emotional or behavioral conditions: Apply this code if your patient shows severe anxiety, high reactivity, or low impulse control that affects the therapeutic process, making the session more challenging and requiring extra effort.
- Third-party involvement: This applies when the presence of family members, interpreters, or other third parties is necessary and significantly complicates communication between you and your patient.
- Mandated reporting: Use this in cases where you must address issues related to mandated reporting, such as incidents of abuse or neglect, which add complexity to the session.
Keep in mind that just one of these factors may not suffice to justify using 90785 (we’ll cover the billing criteria next) and that it cannot be used in every session with a “difficult” client. The interactive complexity must significantly affect the delivery of care and require extra effort beyond what is typical in a standard psychotherapy session.For proper usage of CPT code 90785, make sure to document the specific factors contributing to the interactive complexity and how they affected the session. This documentation will support the need for using the add-on code and help justify any additional reimbursement.
When Not to Use CPT Code 90785
It should be noted that interactive complexity cannot be used in conjunction with:
- Family psychotherapy codes (90846 and 90847)
- Psychotherapy for crisis codes (90839 and 90840)
- Psychological and Neuropsychological Testing codes (96130, 96131, 96132, 96133, 96134, 96136, 96137, 96138, 96139, 96146)
- Adaptive behavior codes (97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T)
In addition, do not report 90785 for the purpose of translation or interpretation services.Although 90785 can be reported in conjunction with 90853 for a specified patient when group psychotherapy includes interactive complexity, it should not be reported for every patient participating in the group service.Finally, interactive complexity is not applicable to an evaluation and management (E/M) service alone, even when performing an E/M with a psychotherapy service.
Requirements and Billing Criteria for CPT Code 90785
To correctly bill CPT code 90785, you need to follow specific documentation and billing criteria. Here are the main requirements:
- Interactive complexity factors: Clearly identify the elements that contribute to the interactive complexity of the session, such as communication difficulties, emotional or behavioral conditions, third-party involvement, or issues related to mandatory reporting.
- Time spent: CPT code 90785 is an add-on code and does not require a specific amount of time. However, ensure that the primary psychotherapy service code you bill with 90785 meets its time requirements.
- Billing with primary codes: You can only bill 90785 along with psychotherapy CPT codes 90832, 90834, 90837, or with the intake code 90791.
- Once per session: Bill 90785 only once per session, regardless of how many interactive complexity factors are present.
- Medical necessity: As with all services, the use of 90785 must be medically necessary and supported by clinical documentation.
When documenting interactive complexity, provide specific details about the factors that increased the session's complexity and required additional effort. This may include:
- Descriptions of communication barriers and how they were addressed
- Specific emotional or behavioral conditions and their impact on the session
- The role and involvement of third parties
- Issues related to mandated reporting and how they were handled
Proper documentation is important to justify the use of 90785 and avoid billing errors or claim denials. Regularly review your billing practices and stay informed about any changes to CPT codes and billing guidelines to ensure compliance and receive appropriate payment for your services.
How to Increase your CPT Code 90785 Reimbursement
To ensure full reimbursement for CPT code 90785, consider these strategies and practical tips:
- Accurate documentation: Clearly record the specific factors contributing to the interactive complexity of the session, such as communication barriers, emotional or behavioral conditions, third-party involvement, or mandated reporting issues. Provide details on how these factors affected the session and required additional effort.
- Proper coding: Use CPT code 90785 only when the interactive complexity significantly impacts the delivery of care and requires extra effort beyond a standard psychotherapy session. Avoid incorrect coding, which can lead to claim denials or compliance issues.
- Combine with appropriate primary codes: Bill 90785 alongside the correct primary psychotherapy CPT codes (90832, 90834, 90837) or the diagnostic evaluation code (90791). Ensure that the primary code meets its time requirements.
- Verify patient information: Double-check patient information, including insurance coverage, to prevent claim denials due to ineligibility or mismatched data.
- Stay updated on guidelines: Regularly review and stay informed about updates to CPT codes, billing guidelines, and regulatory requirements to maintain compliance and avoid errors.
- Use technology: Take advantage of medical billing software that integrates with your EHR system to automate tasks, reduce manual entry errors, and improve coding accuracy. Features like real-time eligibility verification can help prevent claim denials.
- Conduct regular audits: Perform periodic internal audits of your billing and coding practices to identify areas for improvement, catch errors, and ensure compliance with best practices and guidelines.
Following these strategies will help streamline your billing process, minimize claim denials, and ensure you receive appropriate reimbursement for using CPT code 90785 when warranted by the complexity of the psychotherapy session.
Frequently Asked Questions (FAQ)
What does CPT code 90785 represent?
CPT code 90785 is an add-on code indicating interactive complexity in psychotherapy sessions. It shows that the session required extra effort due to communication difficulties, emotional or behavioral conditions, third-party involvement, or mandated reporting issues.
Can I bill 90785 on its own?
No, 90785 cannot be billed on its own. It must accompany a primary psychotherapy CPT code (90832, 90834, 90837) or the diagnostic evaluation code (90791).
How many times can I bill CPT code 90785 per session?
You can bill CPT code 90785 only once per session, no matter how many interactive complexity factors are present. Ensure you document the specific factors that contributed to the interactive complexity and how they impacted the session.
Does using CPT code 90785 require extra time?
No specific time is needed for CPT code 90785. However, the primary psychotherapy service code billed with 90785 must meet its own time requirements for proper billing.
Can I use CPT code 90785 with any psychotherapy session type?
CPT code 90785 can be used with individual or group psychotherapy sessions, provided the interactive complexity criteria are met and it is billed with an appropriate primary psychotherapy code.
What documentation supports the use of CPT code 90785?
To justify using CPT code 90785, documentation should clearly identify the factors that added to the session's interactive complexity, such as:
- Communication barriers and how they were addressed
- Emotional or behavioral conditions and their impact on the session
- The role and involvement of third parties
- Issues related to mandated reporting and how they were handled
Provide details on how these factors affected the session and required more effort than a standard psychotherapy session.
90785 Billing Code Limitations
While CPT code 90785 can help increase reimbursement for complex psychotherapy sessions, it's important to be aware of its limitations to avoid claim denials or compliance issues:
- Standalone billing: You cannot bill 90785 on its own. It must always accompany a primary psychotherapy CPT code (90832, 90834, 90837) or the diagnostic evaluation CPT code (90791) .
- Once per session: CPT code 90785 can only be billed once per session, regardless of the number of interactive complexity factors present. Billing it multiple times for the same session will likely result in claim denials.
- Time requirements: Although 90785 does not have a specific time requirement, the primary psychotherapy code billed with it must meet its own time criteria. Failing to meet these time requirements may lead to denied claims.
- Documentation: Proper documentation is necessary to justify the use of 90785. Claims lacking sufficient documentation of the interactive complexity factors and their impact on the session may be denied.
- Medical necessity: As with all services, the use of 90785 must be medically necessary. Overusing or misusing this code without proper justification can attract attention and lead to audits or compliance issues.
To reduce claim denials and ensure compliance when using CPT code 90785:
- Confirm that the interactive complexity significantly impacts the session and requires extra effort beyond a standard psychotherapy session.
- Use 90785 only with appropriate primary psychotherapy codes and ensure that the primary code meets its time requirements.
- Clearly document the specific factors contributing to the interactive complexity and how they affected the session.
- Keep informed on billing guidelines and regulations related to 90785 to avoid misuse or non-compliance.
