CPT Code 90839: When to Use and How to Maximize Reimbursement for Therapists

Understanding billing codes can feel overwhelming for any therapist. However, using the right codes ensures you receive proper payment for your services. One important code every therapist should know is 90839.

Let’s break down the 90839 CPT code and how you can best use it, covering: its usage criteria, billing requirements, and its limitations. When you know when and how to use this code effectively in your practice, it can help you receive the correct reimbursement while offering the best care to your clients.

What is the 90839 CPT Code?

‍Therapists use the 90839 CPT code to bill for psychotherapy services during crisis situations, specifically for the initial 60 minutes of treatment. This code helps therapists receive payment for providing immediate, high-intensity interventions to patients facing acute psychological distress or crisis.

When to Use 90839

‍The 90839 CPT code applies to billing psychotherapy services during crisis situations that demand immediate, high-intensity interventions. Here are some specific situations where using the 90839 code makes sense:

• Acute psychological distress: When a patient suffers from severe, acute symptoms like panic attacks, suicidal thoughts, or extreme anxiety that significantly affect their functioning and require immediate intervention.
• Behavioral health emergencies: Instances where a patient's behavior poses a risk to themselves or others, such as self-harm, aggression, or psychosis, requiring urgent psychological care.
• Trauma or crisis response: When a patient’s symptoms have increased significantly due to  recently experiencing a traumatic event, such as sexual assault, domestic violence, or the sudden loss of a loved one, which requires immediate and specialized crisis-related psychological support.
• Significant life stressors: When a patient encounters overwhelming life challenges, such as job loss, divorce, or serious illness, leading to a state of crisis and serious mental health symptoms, such as severe sleeplessness, significant angry outbursts, or suicidal thoughts demanding prompt, intensive mental health care.

The 90839 code should only be used for the first 60 minutes of psychotherapy during a crisis. If the session goes beyond 60 minutes, the add-on code 90840 can be used for each additional 30 minutes of service.

When using the 90839 code, therapists must document the nature of the crisis, the immediate interventions used, and the patient's response to treatment. This documentation is necessary for justifying the use of the code and ensuring proper reimbursement.

Requirements and Billing Criteria for 90839

‍To receive proper reimbursement when billing the 90839 CPT code, therapists need to meet specific documentation and eligibility criteria. Here are the key requirements:

• Medical necessity: The documentation must clearly show the medical necessity for the crisis psychotherapy service. Connect the 90839 code to the appropriate ICD-10-CM diagnosis code that supports the need for immediate, high-intensity intervention.
• Service duration: The 90839 code covers the first 60 minutes of psychotherapy during a crisis. If the session continues beyond 60 minutes, use the add-on code 90840 for each additional 30 minutes of service.
• Same-day services: If other services are provided on the same day, such as evaluation and management (E/M) services, the documentation must confirm that each service was separate, distinct, and medically necessary.
• Time spent with the patient: The medical record should clearly reflect the time spent providing crisis psychotherapy services and demonstrate that the entire duration was necessary for the patient's care.
• Legibility and detail: Ensure all documentation is legible and includes necessary details, such as the nature of the crisis, interventions used, and the patient's response to treatment.
• Provider credentials: If applicable, include the identity and credentials of the supervising physician and any staff members involved in providing the service.

Proper documentation is essential for justifying the use of the 90839 code and avoiding claim denials or audits. Regularly review and update your documentation practices to stay compliant with the latest billing guidelines and regulations.

How to Improve Your 90839 Reimbursement

‍Optimizing your billing practices is key to ensuring full reimbursement for crisis psychotherapy services billed under the 90839 CPT code. Here are some strategies to help you improve your reimbursement:

• Stay informed and compliant: Keep up with the latest updates on billing codes, reimbursement rates, and policy guidelines from payers. Attend webinars, subscribe to industry newsletters, and participate in forums to stay ahead of changes that may impact your billing practices.
• Ensure accurate coding and documentation: Properly document the nature of the crisis, interventions used, and the patient's response to support the medical necessity of the 90839 code. Use electronic health records (EHR) or digital documentation systems to capture all relevant details and avoid errors such as incorrect coding or insufficient documentation.
• Use technology and automation: Implement practice management software, automated claim scrubbing tools, and electronic remittance advice (ERA) processing to improve billing efficiency and accuracy. Use patient portals for online bill pay and communication to streamline the payment process.
• Handle the appeals process effectively: Be prepared to appeal denied claims and prior authorizations to improve reimbursement opportunities. Familiarize yourself with the payer's appeals process and submit appeals promptly with supporting documentation.

Frequently Asked Questions (FAQ)

What is the difference between 90839 and 90840?

• 90839: This code applies to the first 60 minutes of psychotherapy during a crisis situation that requires immediate, intense intervention.
• 90840: This is an additional code used for each extra 30 minutes of crisis psychotherapy after the initial 60 minutes billed with 90839.

Can I bill 90839 for a regular therapy session?
No, the 90839 code is specifically for crisis situations that need immediate, intense intervention. For a regular 60-minute therapy session, you should use the 90837 code instead.

How do I document the use of 90839?
When using the 90839 code, clearly document the nature of the crisis, the immediate interventions provided, and the patient's response to treatment. This documentation is important for justifying the use of the code and ensuring proper reimbursement.

Is there a limit to how many times I can bill 90839 for a single patient?
There is no specific limit on how often you can bill 90839 for a single patient. However, each use of the code must be medically necessary and properly documented. Overuse or misuse of the code may lead to claim denials or audits.

Can I bill 90839 and an evaluation and management (E/M) code on the same day?
Yes, you can bill 90839 and an E/M code on the same day, as long as the documentation supports the medical necessity of each service and shows that they were separate and distinct.

90839 Bill Code Limitations

‍While the 90839 CPT code serves a critical role in billing for crisis psychotherapy services, it's important to understand its limitations and restrictions to ensure accurate billing and reimbursement. Here are some key limitations associated with the 90839 code:

• Time-based coding: The 90839 code applies specifically to the first 60 minutes of crisis psychotherapy. If the session goes beyond 60 minutes, the add-on code 90840 must be used for each additional 30 minutes. Incorrect use of these codes can lead to billing errors and claim denials.
• Documentation requirements: To justify using the 90839 code, therapists must provide detailed documentation of the crisis situation, interventions used, and the patient's response. Insufficient or unclear documentation can result in claim rejections or audits.
• Medical necessity criteria: The 90839 code is reserved for situations where the patient experiences acute psychological distress or a behavioral health emergency that requires immediate, high-intensity intervention. Using this code for non-crisis situations can lead to denials, compliance issues, and potential penalties.
• Same-day service restrictions: When billing 90839 alongside other services provided on the same day, such as evaluation and management (E/M) services, therapists must ensure that each service is separate, distinct, and medically necessary. Failure to properly document and distinguish these services can result in claim denials.
• Frequency limitations: Although there is no specific limit on how often the 90839 code can be used for a single patient, overuse or misuse of the code may trigger audits or investigations. Therapists must ensure that each use of the code is medically necessary and appropriately documented.

These limitations highlight the need for accurate coding, detailed documentation, and compliance with billing guidelines when using the 90839 CPT code. Therapists should stay informed about updates to coding policies and payer requirements to minimize the risk of claim denials and ensure proper reimbursement for their crisis psychotherapy services.