CPT Code 90785 – Interactive Complexity Add-On for Psychiatry and Behavioral Health Billing

This code is used when providing psychiatric or behavioral health services in situations that increase the complexity of care.

Explanation

This code is billed in addition to the primary psychiatric service code. It is used when certain factors make the treatment process more complex. These factors are specifically limited to:

• The need to manage disruptive communication that interferes with the delivery of care
   
• Complications in implementing the treatment plan due to the caregiver’s behavioral or emotional interference
   
• Sentinel events that require disclosure to a third party, followed by discussion and/or reporting to the patient(s)
   
• The use of play equipment or a translator to overcome communication barriers

Important Coding Tips

This code can be reported with psychiatric evaluation services (90791–90792), psychotherapy services (90832–90834, 90836–90838), and group psychotherapy (90853).

However, do not report this code with:

• Psychotherapy for crisis (90839–90840)
   
• Psychological and neuropsychological testing (96130–96134, 96136–96139, 96146)
   
• Adaptive behavior assessment or treatment services (97151–97158, 0362T, 0373T)
   
• E/M services provided without psychotherapy

Documentation Tips For CPT Code 90785

The documentation should clearly specify the type of interactive methods used, such as an interpreter, play techniques, or any physical device utilized. It must also indicate that the patient was unable to communicate through normal verbal means.

Other catatonic states may also be covered if proper documentation is submitted with the claim.

Coverage includes interactive examinations for patients with primary psychiatric diagnoses (excluding dementias and sleep disorders) along with one of the following conditions:

• Developmental speech or language disorders
• Conductive hearing loss
• Deaf mutism
• Aphasia
• Voice disturbances
• Aphonia
• Other speech disturbances, such as dysarthria or dysphasia
   

These conditions must be clearly and concisely recorded in the medical record.

Additionally, the time spent by the clinician providing interactive complexity services should be reflected in the timed psychotherapy service code or the psychotherapy add-on code when provided in conjunction with an E/M service.

Reimbursement Tips For CPT Code 90785

The performing provider may report telemedicine services by adding modifier 95 to this procedure code and using the appropriate place of service.

Services at the originating site should be reported with HCPCS Level II code Q3014.

According to the Correct Coding Initiative, “Interactive services (diagnostic or therapeutic) are distinct services for patients who have lost, or have not yet developed, the expressive language communication skills needed to explain their symptoms and response to treatment…”

Interactive complexity for psychiatric services is reported with the add-on CPT code 90785.

When a clinical social worker provides this service, assignment of benefits is required. Medicare reimburses at 75% of the physician fee schedule when performed by a clinical social worker.

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