In the field of mental health and behavioral therapy, accurate billing and coding are essential for ensuring that healthcare providers receive appropriate compensation for their services. One of the most commonly used codes in this area is procedure code 90837. Understanding what this code represents and when to use it is crucial for mental health professionals and billing specialists alike.
Mental health professionals use procedure code 90837, a CPT (Current Procedural Terminology) code, to bill for psychotherapy services. Specifically, it represents a 60-minute session of individual psychotherapy with a patient. Psychologists, psychiatrists, licensed clinical social workers, and counsellors widely use this code to provide in-depth therapy sessions to patients?
Mental health professionals use procedure code 90837 when they conduct a psychotherapy session that lasts 60 minutes. It is important to note that this code is specifically for individual therapy sessions, where the focus is on one-on-one interaction between the therapist and the patient.
Mental health professionals typically use this code for sessions involving more intensive therapy, often addressing complex psychological issues such as major depressive disorder, anxiety disorders, post-traumatic stress disorder (PTSD), and other serious mental health conditions. The session may include various therapeutic techniques, such as cognitive-behavioral therapy (CBT), psychodynamic therapy, or other evidence-based approaches, tailored to the patient’s needs.
Understanding the distinctions between different psychotherapy codes is essential for accurate billing. Here’s a comparison of procedure code 90837 with other common psychotherapy CPT codes:
Procedure code 90837 should be used when the therapy session lasts for 60 minutes and involves individual psychotherapy. This code is appropriate when the patient requires a full hour of therapeutic intervention to address complex mental health issues.
It is important to document the session thoroughly, noting the duration, the therapeutic techniques used, and the patient’s progress. Accurate documentation not only supports the use of procedure code 90837 but also ensures compliance with billing regulations and helps avoid potential audits.
The Importance of Procedure Code 90837 in Mental Health Billing
Procedure code 90837 is a crucial tool in mental health billing. It reflects the time and effort invested by the therapist in providing comprehensive care to the patient. Accurate use of this code helps ensure that mental health professionals are compensated fairly for their services.
Maximizing Reimbursement with Procedure Code 90837
Proper use of procedure code 90837 can significantly impact a practice’s revenue. Since this code represents a longer session, it typically results in higher reimbursement compared to shorter sessions. However, it is essential to use this code accurately and in accordance with payer guidelines.
Some insurance companies may require pre-authorization for sessions billed under code 90837, especially if the patient requires multiple 60-minute sessions over a short period. Ensuring that pre-authorization is obtained, when necessary, can help avoid claim denials and delays in payment.
Despite its importance, there are challenges associated with the use of code 90837. These challenges include:
In addition to procedure code 90837, mental health professionals use several other CPT codes for billing various types of psychotherapy and behavioral therapy services. Here’s an overview of some related codes:
Individual Therapy
Family Therapy
Group Therapy
Crisis Intervention
Accurate coding also involves the use of ICD-10 codes to describe the patient’s diagnosis. These codes provide the clinical rationale for the psychotherapy sessions and are necessary for justifying the use of CPT codes like 90837. Here are some common ICD-10 codes used in conjunction with code:
Additional Considerations
Modifiers may also be required depending on the services provided. For example, the 59 modifier might be needed for distinct procedural services, while the 25 modifier could be used for significant, separately identifiable evaluation and management (E/M) services.
To maximize the benefits of using procedure code 90837, mental health professionals should follow these best practices:
1. Verify Insurance Coverage
Before scheduling a 60-minute session, verify the patient’s insurance benefits to ensure that code is covered. This step helps prevent unexpected denials and ensures that the patient understands their financial responsibility.
2. Document Thoroughly
Thorough documentation is critical when using code 90837. The session notes should include details about the therapeutic interventions used, the patient’s response, and any progress made. Detailed documentation supports the use of the code and provides a clear record of the patient’s treatment.
3. Monitor Claim Status
After submitting claims using procedure code, monitor the status to ensure timely reimbursement. If a claim is denied, review the reason for the denial and take corrective action, such as providing additional documentation or resubmitting the claim.
4. Stay Updated on Coding Guidelines
Mental health billing regulations and coding guidelines can change over time. Staying informed about the latest updates ensures that procedure code 90837 is used correctly and in compliance with payer requirements.
Procedure code 90837 is a valuable tool for mental health professionals, allowing them to bill for 60-minute psychotherapy sessions. By understanding when and how to use this code, providers can ensure accurate billing, maximize reimbursement, and avoid potential claim denials.
However, the complexities of mental health billing extend beyond just one code. To manage your billing process effectively, consider outsourcing to professionals who specialize in mental health and behavioral billing services. This allows you to focus on patient care while ensuring that your billing is handled efficiently and accurately.
If you need expert Mental Health or Behavioral Billing Services, contact us today. Our team of professionals is ready to help you navigate the complexities of mental health billing, maximize your reimbursements, and support the financial stability of your practice.