Pediatric Psychotherapy Coding: Guidelines for Accurate Selection

Table of Contents

Basics of CPT code 90832-90838 & CPT code 90846-90847

Selecting the appropriate code for pediatric psychotherapy requires consideration of both the duration of the session and the participants involved. Coding can become particularly complex when parents are involved in therapy, necessitating a distinction between family-based psychotherapy (CPT code 90846, 90847) and individual therapy (CPT code 90832-90838). Understanding the key differences between these types of psychotherapy and how to accurately account for time will simplify the coding process.

Individual vs. Family Psychotherapy

Psychotherapy is commonly utilized in the treatment of mental health and behavioral disorders, with physicians and other qualified healthcare professionals (QHPs) often providing both individual and family therapy sessions.

Individual Psychotherapy: This form of therapy focuses on the personal experiences, emotions, and thoughts of a single individual. The clinician works directly with the patient to explore their feelings, behaviors, and cognitive processes, with the goal of improving the patient’s mental health, coping strategies, and self-awareness. According to CPT® guidelines, “The patient must be present for all or a majority of the service.” Although informants (such as parents) may be present, they are not the focus of the session.
Family Psychotherapy: In contrast, family psychotherapy involves the participation of family members, focusing on the interpersonal dynamics within the family unit. The clinician works with the family to enhance communication, resolve conflicts, and address issues impacting the entire family. This approach may include work with the family as a whole or in smaller sub-groups to tackle specific challenges.

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Billing and Coding Specifications

To ensure accurate coding and billing for psychotherapy services, consider the following guidelines:

Pre-session Requirements: Before initiating therapy services, a diagnostic assessment should be conducted to evaluate the individual’s mental status, symptoms, behaviors, and cognitive processes. This assessment helps determine an appropriate treatment plan based on the patient’s diagnosis. Exceptions to this may exist in crisis situations.
Blended Sessions: If an encounter includes both individual and family therapy components, the code for the predominant service provided should be used. For instance, if a session involves 30 minutes focused on family dynamics with the patient present and 20 minutes dedicated to individual therapy, report CPT 90847 (family psychotherapy with the patient present, 50 minutes). According to CPT guidelines, it is also acceptable to report both individual and family services on the same day, provided the services are distinct and meet the required time criteria.
Time Spent: Accurate documentation of the start/stop times and total duration of each session is essential. Only face-to-face time with the patient or family should be counted toward the total session time. Time spent on documentation, administrative tasks, or non-patient-related activities should not be included.Avoid rounding up or altering the time to meet the criteria for a higher-level service. However, the code should reflect the closest actual time spent in therapy. For example:
- Individual Therapy:
  - 90832/90833: 16-37 minutes
  - 90834/90836: 38-52 minutes
  - 90837/90838: 53 or more minutes
- Family Therapy (with or without patient present):
  - 90846/90847: 26 or more minutes
Note that psychotherapy codes should not be billed for sessions lasting less than 16 minutes for individual therapy or less than 26 minutes for family therapy.
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Psychotherapy is a variety of treatment techniques in which a physician or other qualified health care provider helps a patient with a mental illness or behavioral disturbance identify and alleviate any emotional disruptions, maladaptive behavioral patterns, and contributing/exacerbating factors. This treatment also involves encouraging personality growth and development through coping techniques and problem-solving skills. CPT code 90832 is reported 90832 for one half hour of face-to-face time spent with the patient without an additional evaluation and management (E/M) service. CPT code 90833 is reported if a separate E/M service is performed during the same encounter as the 30 minutes of psychotherapy

CPT code 90834 is reported for 45 minutes of face-to-face time spent with the patient without an additional evaluation and management (E/M) service. CPT code 90836 is reported if a separate E/M service is performed during the same encounter as the 45 minutes of psychotherapy.

CPT code 90837 is reported for one hour of face-to-face time spent with the patient without an additional evaluation and management (E/M) service. CPT code 90838 is reported if a separate E/M service is performed during the same encounter as the 60 minutes of psychotherapy.

The therapist conducts a 50-minute family psychotherapy session, where the provider meets jointly with the patient and the family. The family actively participates in the patient’s evaluation and treatment process. The primary focus of the session is to address family dynamics in relation to the patient’s mental health and behavior. Additionally, the therapist examines the impact of the patient’s condition on the family unit, with the goal of enhancing the interaction and communication between the patient and family members. The session includes reviewing medical records, coordinating with other healthcare providers, observing and interpreting behavioral and communication patterns, and making treatment decisions, including medication management and any related physical examinations.