4 Essential Tips for Pediatric Psychotherapy Coding

4 Essential Tips for Pediatric Psychotherapy Coding

Coding for pediatric psychotherapy can be complex, especially when sessions often involve parents or other family members. To code accurately, clinicians must determine whether the therapy should be categorized as individual (CPT® 90832-90838) or family-based (CPT® 90846, 90847). By understanding key distinctions and following time-based coding guidelines, providers can simplify the process.




Individual vs. Family Psychotherapy

Psychotherapy is often a medically necessary intervention for addressing mental health or behavioral issues in children. Qualified healthcare professionals (QHPs) typically provide these services, either as individual or family therapy.

Individual Psychotherapy: This type of therapy focuses solely on the child’s personal experiences, emotions, and behavior. The clinician works one-on-one with the child to explore their thoughts and feelings, helping them develop coping mechanisms and gain insight into their mental health. According to CPT® guidelines, “The patient must be present for all or a majority of the service.” Parents or caregivers may attend, but their role is not the focus of treatment.

Family Psychotherapy: Family therapy addresses the dynamics within the family unit. The clinician works with the family to improve communication, resolve conflicts, and address behavioral concerns that affect all members. This type of therapy often includes the patient and focuses on enhancing the family’s overall functioning. The clinician may work with the entire family or sub-groups to tackle specific challenges.

4 Tips for Accurate Pediatric Psychotherapy Coding

To ensure proper billing and documentation, consider the following best practices:

1. Complete Pre-Session Assessments: Before starting therapy, a diagnostic assessment should be conducted to evaluate the patient’s mental status, symptoms, and behaviors. This assessment guides the treatment plan and determines the appropriate therapy type. Exceptions may apply in crisis situations where immediate therapy is required.

2. Coding for Blended Sessions: When a session includes both individual and family therapy components, the predominant service should determine the code. For instance, if 30 minutes of the session involve family therapy (with the patient present) and 20 minutes focus on the individual patient, you would bill CPT® 90847 for Family Psychotherapy (50 minutes). However, CPT® guidelines allow billing for both individual and family sessions on the same day if they are separate, distinct, and meet time requirements.

3. Follow Time-Based Coding Rules: Proper documentation of the session’s start, stop, and total time is essential. Only face-to-face time spent with the patient or family counts toward the total time. Time spent on tasks like documentation or care coordination does not qualify.

·         Individual Psychotherapy Codes:

o    90832/90833: 16-37 minutes

o    90834/90836: 38-52 minutes

o    90837/90838: 53 or more minutes

·         Family Psychotherapy Codes:

o    90846/90847: 26 or more minutes

Do not round up or alter time to meet the next service level. Choose the code that most closely matches the actual time spent. Additionally, sessions lasting less than 16 minutes (individual) or 26 minutes (family) should not be billed using psychotherapy codes.

4. Maintain Detailed Documentation: Therapeutic notes should address the patient’s progress toward their treatment goals. Include specific details about the progress made or any challenges encountered. Ensure the documentation is unique and tailored to each individual or family member involved. Avoid duplicating notes between participants.

Providing Effective Support

By understanding the differences between individual and family psychotherapy, clinicians can ensure accurate coding and billing. Properly identifying the type of therapy and adhering to CPT® guidelines allows providers to focus on delivering quality care that meets the needs of children and their families.


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