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Want to Make More Money in Your Psych Practice?

If you have been billing in the insurance world, you know that reimbursement is challenging at best. There are some ways to boost reimbursement, if the situation is applicable. As always, make sure your documentation covers the code in which you are seeking reimbursement. If there are communication difficulties during your visit, you may be able to add-on the Interactive Complexity (90785) code to the patients visit.

According to CMS, the Interactive Complexity (90785) is an add-on code specific for psychiatric services and refers to communication difficulties during the patients visit with the provider. Remember that add-on codes may only be reported in conjunction with other codes, never alone. Reimbursement for this code is going to vary per insurance payor but adding it on when appropriate could add up.

You may have specific situations that may qualify for this code.

  • Individuals that have someone else legally responsible for their care.

  • Minors or adults with guardians / or legal representatives

  • Individuals that request others be involved in their care during the visit (adults accompanied by one or more participating family members, or interpreter or language translator).

  • Individuals that require the involvement of other third parties - child welfare (CPS) parole/probation officers, or schools

This code may be used with visits where at least one of the following communication difficulties are present.

  • 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.

  • Caregiver emotions/behavior that interfere with implementation of the treatment plan.

  • Evidence/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.

  • Use of play equipment, physical devices, interpreter or translator to overcome significant language barriers.

Do not report the CPT add-on code for Interactive Complexity code when you are using psychotherapy for crisis codes or with E/M services when no psychotherapy service is also reported.

Reference: CMS Document

At the time of this writing, March 2021 - this is still an accurate code. Please be aware that coding decisions and definitions change. When in doubt, do your own research into the codes you are billing to make sure you are staying within the guidelines.

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