1. 2013 CPT Coding Changes Julie E Larish, CPC 1

2. CPT coding and documentation – Whose job is it? American Psychiatric Association Documentation and coding is part of physician work You are responsible for the clinical work and equally responsible for the documentation and coding This should not be the job of your staff! 2

3. Overview of changes implemented in 2013 Key codes have been deleted, e.g. 90862 Pharmacologic Management Key services have been assigned Established numbers and/or are described differently, and all Established codes can be used in all settings There are now two codes for an initial evaluation; one with medical services and one without Psychotherapy is no longer distinguished by site of service Psychotherapy with E/M is now an E/M code with a Psychotherapy add-on There is a Established crisis psychotherapy code Work previously described using the interactive codes is now done by using an add-on code 3

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7. Timeline August 31, 2012 November 2012 January 1, 2013 CPT electronic files released; changes to CPT codes public CMS releases the Final Rule on the 2013 Physician Fee Schedule (includes relative values) Established code set goes in to effect – must bill using Established CPT codes 7

8. Pharmacologic Management Medication Support Service with or without Psychotherapy 8

9. Pharmacologic Management 90862 has been DELETED Psychiatrists should use the appropriate E/M series code (99xxx) to report this service A Established add-on code – 90863 – has been added to describe pharmacologic management when performed by a prescribing psychologist; Physicians should NEVER use 90863 9

10. Psychotherapy with E/M is now reported by selecting the appropriate E/M service code (99xxx series) and the appropriate psychotherapy add-on code The E/M code is selected on the basis of the site of service and the key elements performed The psychotherapy add-on code is selected on the basis of the time spent providing psychotherapy and does not include any of the time spent providing E/M services If no E/M services are provided, use the appropriate psychotherapy code (90832, 90834, 90837) 10

11. 11 Medication Management with or without psychotherapy is now recorded with E/M codes New PATIENT in OUTPATIENT SETTING 99201 – New Patient Office Visit – Problem Focused w/ Straightforward decision making (10) 99202 – New Patient Office Visit – Expanded Problem Focused w/Straightforward decision making (20) 99203 – New Patient Office Visit – Detailed w/Low Complexity decision making (30) 99204 – New Patient Office Visit – Comprehensive w/Moderate Complexity decision making (45) 99205 – New Patient Office Visit – Comprehensive w/High Complexity decision making (60)

12. 12 Established PATIENT in OUTPATIENT SETTING 99211 – Established Patient Office Visit – Problem Focused w/ Straightforward decision making 99212 – Established patient Office Visit – Expanded Problem Focused w/Straightforward decision making 99213 – Established Patient Office Visit – Detailed w/Low Complexity decision making 99214 – Established Patient Office Visit – Comprehensive w/Moderate Complexity decision making 99215 – Established Patient Office Visit – Comprehensive w/High Complexity decision making

13. 13 PATIENTS in INPATIENT SETTING 99221 – Initial hospital care – Detailed w/ Low decision making 99222 – Initial hospital care – Detailed w/ Moderate decision making 99223 – Initial hospital care – Detailed w/ High decision making 99231 – Subsequent Hospital Care – Problem focused w/low complexity 99232 – Subsequent Hospital Care – Expanded problem focused w/moderate complexity 99233 - Subsequent Hospital Care – Detailed w/high complexity

14. ELEMENTS NEEDED FOR E/M DOCUMENTATION 1997 CMS Documentation Guidelines for Evaluation and Management Services – Abridged & Modified for Psychiatric Services 14

15. 15 99201 OutptMedication/ New patient/Problem focused 99202 OutptMedication/ New patient/Expaned problem focused 99203 OutptMedication/ New patient/Low Complexity 99204OutptMedication/ New patient/Moderate Complexity 99205OutptMedication/ New patient/High Complexity 99211OutptMedication/Established/Problem focused 99212OutptMedication/Established/Expaned problem focused 99213OutptMedication/Established/Low complexity 99214OutptMedication/Established/Moderate complexity 99215OutptMedication/Established/High complexity 99221InptMedication/Initial Day/Low complexity 99222InptMedication/Initial Day/Moderate complexity 99223InptMedication/Initial Day/High complexity 99231InptMedication/Subsequent Day/Low complexity 99232InptMedication/Subsequent Day/Moderate Complexity 99233InptMedication/Subsequent Day/High Complexity M0064OutptMedication monitoring

16. 16 9921199212992139921499215 MinimalProblem FocusedExp Problem FocusedDetailedComprehensive At Least 1: At Least 1At Least 4: or At Least 3: H Location Location Chronic DX P Quality Quality Chronic DX I Severity Severity Chronic CX Duration Timing Context Modifying factors Assoc Signs & Symptoms R No ROS Constitutional O Eyes/ENT/Mouth S CV Respiratory GI GU Musculoskeletal Skin/Breast Neuro Psych Endocrine Hem/Lymph Allergy/Immun All others negative PNo PFSH At least 2 requiredAll 3 F Past medical S Family History H Social History ConstitutionMeasurement of any 2 of 7 vital signs Sitting or standing BP Supine BP Respriations Ttempreture Pulse Rate & regularity Height Weight General Appearance Development Deformaties Nutrition Body Habitus Attention to grooming MusculoskeletalAssessment of Muscle Stength & Tone Flaccid Cog Wheel Spastic Examination of Gait & Station Antalgic Hip Extensor Spastic Atxic Myopathic Steppage Festinating Paraplegic spastic Stuttering Helicoped Quadriceps Tqabetic Waddling PsychiatricDescription of Speech rate atriculation volume cohearence Spontaneity with notation of abnormalities - eg. perservation, paucity of language Description of Thought Process rate of thoughts abstracct reasoning Computation content of thoughts eg. Logical, illogical tangential Description of Associations loose tangential intact circumstantial Description of Abnormal or Psychotic Thoughts Hallicinations homicdal delusions Suicidal obessions preoccupation with violence Description of Client's Judgement and Insight Judgement concerning everyday activities and social situations Insight eg. Concerning psychiratric condition Complete Mental Status Examination Orientation to time, place, person Recent and remote memory attention span and concentration language (eg naming objects, repeating phrases fund of knowledge (eg awareness of current events, past history, vocabulary) mood and affect (eg depression, anxiety, agitation, hypomania, lability Medical Decision Making Complexity Straight forwardLow CompexityModerate ComplexityHigh Complexity Diagnosis 1 self limited problem (eg., medication side effect 2 or more sefl limited or minor problems or 1 stabel chronic illness or acute uncomplicated illness (eg exacerbation anxiety) 1 or more chronic illness with mild exacerbation, progression or side effects of tx, or 2 or more stable chronic illnesses or undiagnosed new problem with uncertain prognosis 1 or more chronic illnesses with severe exacerbation, progression, or side effect of tx (eg. Schizophrenia) or acute chronic illness with threat to life (eg. Suicidal or homicidal ideation Data Lab requiring venipuncture UrinalysisPsychological testing Skull film EEG Neurospsycholocial testing Lumbar puncture Suicide risk assessment Management Reassurance Psychotherapy Environmental intervention (eg, agency, school, vocational placement) Referra; for consultation Prescription drug management, open-door seclusion, ETC, Inpatient, Outpatient routine, no comorbid medical conditions Drug therapy requiring intensive moitoring (eg, taperin diazepam for patient in withdrawal), closed-door seclusion, Suicide observation, ECT: patient has comorbid medical condition (eg, cardiovascular disease) Reapid intramuscular neuroleptic administraton, Pharmacolgic restraint (eg, droperidol) Options Avg Time 5 minutes 10 minutes 15 minutes 25 minutes 40 minutes Please pull out this table in your handouts!

17. History Problem focused – chief complaint, brief history of present illness or problem Expanded problem focused – Chief complaint, brief history of present illness, problem pertinent system review Detailed – Chief complaint, extended history of problem, problem pertinent system review extended to include a review of a limited number of additional systems, pertinent past, family and/or social history directly related to client’s problems Comprehensive - Chief complaint, extended history of problem, review of systems that is directly related to the problem(s) identified in the history of the present illness plus a review of all additional body systems, completed past, family and social history 17

18. History requirements 18 9921199212992139921499215 MinimalProblem FocusedExp Problem FocusedDetailedComprehensive At Least 1: At Least 1 At Least 4: or At Least 3: H Location Location Chronic DX P Quality Quality Chronic DX I Severity Severity Chronic CX Duration Timing Context Modifying factors Assoc Signs & Symptoms

19. Review of Systems A ROS is an inventory of body systems obtained through a series of questions seeking to identify signs and/or symptoms which the patient may be experiencing. – A problem pertinent ROS inquires about the system directly related to the problem identified – An extended ROS inquires about the system directly related to the problem(s) identified in the HPI and a limited number of additional systems – A complete ROS inquires about the system(s) directly related to the problems identified in the HPI plus ALL addition body systems 19

20. 20 9921199212992139921499215 MinimalProblem FocusedExp Problem FocusedDetailedComprehensive R No ROS Constitutional O Eyes/ENT/Mouth S CV Respiratory GI GU Musculoskeletal Skin/Breast Neuro Psych Endocrine Hem/Lymph Allergy/Immun All others negative

21. PFSH Past – the patient’s past experiences with illnesses, operations, injuries and treatments Family – a review of medical events in the patient’s family, including diseases which may be hereditary or place the patient at risk Social – an age appropriate review of past and current activities 21 9921199212992139921499215 MinimalProblem FocusedExp Problem FocusedDetailedComprehensive PNo PFSH At least 2 requiredAll 3 F Past medical S Family History H Social History

22. Examination Problem focused – A limited examination of the affected area or system Expanded problem focused – A limited examination of the affected system and other symptomatic or related system(s) Detailed – An extended examination of the affected system and other symptomatic or related system(s) Comprehensive – A general multisystem exam or completed examination of a single organ system. 22

23. When doing an examination – NEVER document “ABNORMAL” Without elaboration of the finding! 23

24. Exam For MD’s in General Health Services 24 Constitution Any three vital signs General Appearance Eyes Conjunctivae & lids Pupils & Irises Optic discs ENT External ears & nose EACs &TMs Hearing Nasal mucosa, septum & turbinates Lips, teeth, & gums Oropharynx Neck Thyroid Respiratory Respiratory effort Percussion Palpation Auscultation Cardio/Vascular Palpation of heart Auscultation Carotids Abdominal aorta Femoral Pedal Pulses Extremities for edema &/or variocosities Chest Inspection of breasts Palpation of breast & axillae GI (abdomen) Masses, tenderness Liver & Spleen Hernia Occult test Anus, perineum & rectum Genitourinary MALE Scrotal contents Penis Prostate gland FEMALE External genitalia Urethra Bladder Cervis Adnexa/parametria Lymph (nodes in two or more areas) Neck Axillae Groin Other Muscular Gait & Station Digits & nailsJoint(s), bones(s), muscles of at least one area: 1) Head, neck 2) spine, ribs & pelvis 3) right upper extremity 4) Left upper extremity 5) Right lower extremity 6) left lower extremity, with exam including: inspection&/or palpation ROM Stability Strength & tone Skin Inspection of skin & subcutaneous tissue Palpation of skin & subcutaeous tissue Neurology Cranial nerves Reflexes Sensation Psychiatric Judgement & insight Orientation time/place/person Memory Mood & affect

25. Exam for Psychiatric Services 25 ConstitutionMeasurement of any 3 of 7 vital signs: Sitting or standing BPRespirationWeight Supine BPTempreture Pulse rate and rgularityHeight General Appearance DevelopmentDeformities NutritionAttention to Grooming Body Habitus MusculoskeletalAssessment of muscle strength and tone FlaccidCog WheelSpastic Examination of Gait and Statiion Antalgichip extnsorspastic ataxicmyopathicsteppage festinatingparaplegic spasticstuttering helicopodquadricepstabetic waddling PsychiatricDescription of Speech ratearticulation volumecoherence spontaneity with notation of abnormalities - eg. perservation paucity of language Description of Thought Processes rate of thoughtsabstract reasoning computation content of thoughts eg. Logical, illogical, tangential Description of Associations loosetangential intact circumstantial Description of Abnormal or Psychotic Thoughts hallucinationshomicidal delusionssuicidal obsessionspreoccupation with violence Description of Client's Judgement and Insight judgement concerning everyday activities & social situations insight eg. Concerning psychiatric condition Complete Mental Status Examination orientation to time, place, person recent and remote memory attention span and concentration Language (eg naming objects, repeating phrases) fund of knowledge (eg, awareness of current events, past history, vocabulary) mood and affect (eg, depresion, anxiety, agitation, hypomania, lability) Problem focused – 1-5 elements in red Expanded problem focused – 6 or more elements in red Detailed - 9 or more elements in red Comprehensive – all elements in red

26. 26 CMS and APA recognize single organ system examinations. If you complete other areas of the body during your examination of the client, your findings must be documented appropriately. * the constitutional measurements may be completed and documented by ancillary personnel. Level of Exam Perform and Document: Problem Focused - One to five elements identified in red. Expanded Problem Focused - At least six elements identified in red. Detailed - At least nine elements identified by a bullet. Comprehensive - Perform all elements identified in red; document every element in each box

27. 27 9921199212992139921499215 MinimalProblem FocusedExp Problem FocusedDetailedComprehensive ConstitutionMeasurement of any 2 of 7 vital signs Sitting or standing BP Supine BP Respriations Ttempreture Pulse Rate & regularity Height Weight General Appearance Development Deformaties Nutrition Body Habitus Attention to grooming MusculoskeletalAssessment of Muscle Stength & Tone Flaccid Cog Wheel Spastic Examination of Gait & Station Antalgic Hip Extensor Spastic Atxic Myopathic Steppage Festinating Paraplegic spastic Stuttering Helicoped Quadriceps Tqabetic Waddling PsychiatricDescription of Speech rate atriculation volume cohearence Spontaneity with notation of abnormalities - eg. perservation, paucity of language Description of Thought Process rate of thoughts abstracct reasoning Computation content of thoughts eg. Logical, illogical tangential Description of Associations loose tangential intact circumstantial Description of Abnormal or Psychotic Thoughts Hallicinations homicdal delusions Suicidal obessions preoccupation with violence Description of Client's Judgement and Insight Judgement concerning everyday activities and social situations Insight eg. Concerning psychiratric condition Complete Mental Status Examination Orientation to time, place, person Recent and remote memory attention span and concentration language (eg naming objects, repeating phrases fund of knowledge (eg awareness of current events, past history, vocabulary) mood and affect (eg depression, anxiety, agitation, hypomania, lability Medical Decision Making

28. Complexity of Medical Decision Making The levels of E/M services recognize four types of medical decision making – Straightforward – Low complexity – Moderate complexity – High complexity Medical decision making refers to the complexity of establishing a diagnosis and/or selecting a management option as measured by: – The number of possible diagnoses and/or the number of management options that must be considered – The amount and/or complexity of medical records, diagnostic tests, and other information that must be obtained, reviewed and analyzed – The risk of significant complications, morbidity, and/or mortality, as well as co-morbidities, associated with the client’s presenting problem(s), the diagnostic procedure(s) and/or the possible management options. 28

29. 29 For each encounter, an assessment, clinical impression, or diagnosis should be documented. It may be explicitly stated or implied in documented decisions regarding management plans and/or further evaluation. For a presenting problem with an established diagnosis the record should reflect whether the problem is: a) improved, well controlled, resolving or resolved; or, b) inadequately controlled, worsening, or failing to change as expected For a presenting problem without an established diagnosis, the assessment or clinical impression may be stated in the form of differential diagnoses or as a "possible", "probable", or "rule out" (R/O) diagnosis. The initiation of, or changes in, treatment should be documented. Treatment includes a wide range of management options including patient instructions, nursing instructions, therapies, and medications. If referrals are made, consultations requested or advice sought, the record should indicate to whom or where the referral or consultation is made or from whom the advice is requested

30. Amount and/or Complexity of Data to be Reviewed If a diagnostic service (test or procedure) is ordered, planned, scheduled, or performed at the time of the E/M encounter, the type of service, eg, lab or x-ray, should be documented. The review of lab, radiology and/or other diagnostic tests should be documented. A simple notation such as "WBC elevated" or "chest x-ray unremarkable" is acceptable. Alternatively, the review may be documented by initialing and dating the report containing the test results. A decision to obtain old records or decision to obtain additional history from the family, caretaker or other source to supplement that obtained from the patient should be documented. Relevant findings from the review of old records, and/or the receipt of additional history from the family, caretaker or other source to supplement that obtained from the patient should be documented. If there is no relevant information beyond that already obtained, that fact should be documented. A notation of “Old records reviewed” or “additional history obtained from family” without elaboration is insufficient. The results of discussion of laboratory, radiology or other diagnostic tests with the physician who performed or interpreted the study should be documented. The direct visualization and independent interpretation of an image, tracing or specimen previously or subsequently interpreted by another physician should be documented. 30

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32. 32 Even though the E/M services are not based on time, THE TIME SPENT FACE TO FACE WITH THE CLIENT MUST BE DOCUMENTED FOR TOTAL TIME TO BE REPORTED TO MEDI-CAL in addition to the psychotherapy time and documentation and travel time! Medi-cal billing = E/M time + Psychotherapy time + Documentation and travel time The psychotherapy add-on code is selected on the basis of the time spent providing psychotherapy and does not include any of the time spent providing E/M services FOR CALIFORNIA ONLY: How to handle an E/M (Medication Management) when psychotherapy is also involved

33. Psychotherapy with E/M vs E/M with psychotherapy 2012 2013 Appropriate 99xxx series code plus one of the following: 90805, 90817 90833, Psychotherapy, 30 minutes when performed with an E/M 90807, 90819 90836, Psychotherapy 45 minutes when performed with an E/M 90809, 90821 90838, Psychotherapy 60 minutes when performed with an E/M 33

34. The psychotherapy add-on code can be billed with the following E/M codes: Outpatient, New Patient 99201 – 99205 Outpatient, established patient: 99211 – 99215 Subsequent hospital care 99231 – 99233 34

35. Psychotherapy 2012 90804, 90816 90806, 90818 90808, 90821 2013 90832, Psychotherapy, 30 minutes 90834, Psychotherapy, 45 minutes 90837, Psychotherapy, 60 minutes 35

36. Important concepts – CPT time rule CPT Time Rule “A unit of time is attained when the mid-point is passed” “When codes are ranked in sequential typical times and the actual time is between two typical times, the code with the typical time closest to the actual time is used.” As an example, codes of 30, 45, and 60 minutes are billed at 16-37 mins, 38-52 mins, and 53-67 mins. (CPT 2013, p xii) 36

37. Important concepts – Add-on code Add-on Code It is a code(s) that describes work that is performed in addition to the primary service It is never reported alone Examples include Psychotherapy, Interactive Complexity and Crisis Services You cannot bill 90833, 90836 or 90838 without an E/M service! Use 90832, 90834 or 90837 if no E/M service was performed! 37

38. Documenting E/M w/Psychotherapy (and interactive complexity) You DO NOT have to write separate notes for the combination of E/M, Psychotherapy and interactive complexity! You DO have to list each code in your documentation and time spent on each code. **remember to include documentation and travel time. You DO have to include all requirements for each code in your documentation You DO have to include any interactive complexity 38

39. Additional Documentation Requirements for E/M w/psychotherapy In addition to all the requirements for E/M services, you must also include the following for psychotherapy: – Review of counseling/therapy given – Changes to treatment plan or plan of care – Other resources used – Type of interactive complexity 39

40. EVERY NOTE WRITTEN IN A CHART MUST INCLUDE DATE OF SERVICE DATE DOCUMENTATION WRITTEN SIGNATURE OF PROVIDER OF SERVICE 40

41. INTERACTIVE COMPLEXITY 90785 Use when one of the following communication factors is present during the visit: The need to manage maladaptive communication (related to, e.g., high anxiety, high reactivity, repeated questions, or disagreement) among participants that complicates delivery of care. 2. Caregiver emotions or behaviors that interfere with implementation of the treatment plan. 3. Evidence or disclosure of a sentinel event and mandated report to a third party (e.g., abuse or neglect with report to state agency) with initiation of discussion of the sentinel event and/or report with patient and other visit participants. 4. Use of play equipment, physical devices, interpreter or translator to overcome barriers to diagnostic or therapeutic interaction with a patient who is not fluent in the same language or who has not developed or lost expressive or receptive language skills to use or understand typical language. 41

42. DO NOT USE 90785 IF: Psychotherapy for crisis (90839, 90840) E/M alone, i.e., E/M service not reported in conjunction with a psychotherapy add-on service Family psychotherapy (90846, 90847, 90849) 42 TYPICAL CLIENTS Have other individuals legally responsible for their care, such as minors or adults with guardians, or Request others to be involved in their care during the visit, such as adults accompanied by one or more participating family members or interpreter or language translator Require the involvement of other third parties, such as child welfare agencies, parole or probation officers, or schools.

43. Important concepts – Interactive Complexity “Interactive” in previous codes was limited in use to times when physical aids, translators, interpreters, and play therapy was used “Interactive Complexity” extends the use to include other factors that complicate the delivery of a service to a patient. These include: – Arguing or emotional family members in a session that interfere with providing the service – Third party involvement with the patient, including parents, guardians, courts, schools – Need for mandatory reporting of a sentinel event 43

44. 44 Add-on code 90785 to be reported with: Diagnostic Evaluations (90791-90992) Psychotherapy (90833-90838) E/M codes (99201-99255; 99304- 99377;99341-99350) Group Psychotherapy (90853) Time spent on Interactive Complexity service is to be reflected in time of psychotherapy code reported Interactive Complexity service is not a factor for selecting E/M code except as it affects key components

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47. PSYCHOTHERAPY WITHOUT E/M SERVICES 47

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49. 49 90832Both16-37 minutes of psychotherapy 90834Both38-52 minutes of psychotherapy 90837Both53 + minutes of psychotherapy 9083290785Both16-37 minutes of psychotherapyInteractive Complexity 9083490785Both38-52 minutes of psychotherapyInteractive Complexity 9083790785Both53 + minutes of psychotherapyInteractive Complexity 90839OutptCrisis first 60 minutes E/M coding can be used if a medical service was also conducted. 90840 OutptCrisis each additional 30 miutes

50. 50 Individual Psychotherapy used in both Outpatient and Inpatient Settings: 90832 - Individual Psychotherapy - Individual psychotherapy, insight oriented, behavior modifying and/or supportive, 16-37 minutes face-to-face with the patient 90834 – Individual Psychotherapy - Individual psychotherapy, insight oriented, behavior modifying and/or supportive, 38-52 minutes face-to-face with the patient 90837 – Individual Psychotherapy - Individual psychotherapy, insight oriented, behavior modifying and/or supportive, 53 + minutes face-to-face with the patient

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52. Prescribing Psychologists If medication review and prescription management happens during a psychotherapy session, 90863 would be added in addition to 90832 90834 90837 52

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54. 54 90839 Psychotherapy for crisis; first 60 minutes +90840 Each additional 30 minutes Example: 120 min of crisis therapy reported: 90839 x 1 90840 x 2 Less than 30 minutes reported with codes 90832 or 90833 (psychotherapy 30 min) Used to report total duration of face-to-face time with the patient and/or family providing psychotherapy for crisis Time does not have to be continuous Provider must devote full attention to patient and cannot provide services to other patients during time period.

55. 55 Psychotherapy for Crisis Services Presenting problem typically life-threatening or complex and requires immediate attention to a patient in high distress Codes include: Urgent assessment and history of crisis state Mental status exam Disposition Treatment includes: Psychotherapy Mobilization of resources to diffuse crisis and restore safety Implementation of psychotherapeutic interventions to minimize potential for psychological trauma

56. 56 Codes for crisis services cannot be reported in combination with: 90791, 90792 (diagnostic services) 90832-90838 (psychotherapy) 90785 (interactive complexity

57. Psychiatric diagnostic evaluation - Overview A distinction has been made between diagnostic evaluations without medical services and evaluations with medical services Interactive services are captured using an add-on code These codes can be used in any setting These codes can be used more than once in those instances where the patient and other informants are included in the evaluation These codes can be used for reassessments Psychiatrists and other medical providers have the option of using 90792 – Psychiatric Evaluation with Medical Management (Assessment with Med Management) 57

58. Assessments (initial psychiatric diagnostic procedures) Two new codes distinguish between an initial evaluation with medical services provided by a physician (90792) and an initial evaluation provided by a non-physician (90791) Initial Evaluation 90791 includes the following: Assessment including history, mental status and recommendations May include communication with family, others, and review and ordering of diagnostic studies 58

59. 59 Initial Evaluation 90792 with medical services and provided by a physician includes those services in (90791) AND: Medical assessment beyond mental status as appropriate May include communication with family, others, prescription medications, and review and ordering of laboratory or other diagnostic studies

60. 60 Psychiatric Diagnostic Codes can be reported once per day. Cannot be reported with an E/M code on same day by same provider. Cannot be reported with psychotherapy service code on same day. May be reported more than once for a patient when separate diagnostic evaluations are conducted with the patient and other collaterals such as family members, guardians, and significant others. Providers must use the patient’s name for services reported under these codes.

61. Codes that Remain the Same 90846 - Family psychotherapy (without the patient present) – (collateral services), which mean sessions with significant persons in the life of the patient, necessary to serve the mental health needs of the patient. Could be only one person in this setting as the “family”. 90847 - Family psychotherapy (conjoint psychotherapy) (with patient present) (Collateral Service) Could be only one person in this setting as the “family”. 90849 – Multiple-Family Group Psychotherapy - Insight Oriented, Behavior Modifying and /or Supportive. CPT code 90849 is used when there are multiple family groups and similar dynamics for clients are being treated. This code is frequently used in hospitals and drug treatment centers where psychotherapy with several different families takes place over their issues surrounding hospitalization of the client or the client’s abuse of substances. Clients may or may not be present, but eh focus must include the clients’ problems, not just the family members’ problems. The therapist would drop an encounter document for each client represented in the group. 90853 - Group psychotherapy (other than of a multiple-family group) Group Therapy, which means services designed to provide a goal directed, face–to–face therapeutic intervention with the patient and one or more other patients who are treated at the same time, and which focuses on the mental health needs of the patients 61

62. All DMH coding structures remain the same. There will need to be extensive adjustments in systems and the clinical medical record to accommodate the federal changes THERE WILL BE NOT DELAYS IN IMPLEMENTATION BY THE FEDERAL GOVERNMENT! 62

63. QUESTIONS? 63