In my graduate program and early career, I would have welcomed the opportunity to gain knowledge about how to run a therapy practice. I needed to learn tasks like credentialing, coding, insurance billing, and claims management. Then there’s weathering the random audits that insurance companies conduct: they monitor clinical documentation, review medical necessity criteria, and verify the proper use of procedure codes, session duration, and proper billing practices.
These audits hinge upon properly recorded CPT codes—or Current Procedural Terminology. Wrongly coded sessions can lead to issues like insurance clawbacks or losing participation in insurance panels.
We’ll go over:
- Defining CPT codes
- Commonly used CPT codes
- CPT code considerations
- Using the wrong CPT code
What are CPT codes?
CPT codes are a universal system that lets providers, insurance companies, hospitals, laboratories, accreditation companies, and other parts of the healthcare system communicate about services and procedures performed. We use these codes to submit claims on behalf of licensed providers like you for the services you perform at UpLift.
When a client is seen by a provider for a counseling session, the provider must identify a procedure code in the progress notes after the session is completed. The CPT code you use will vary based on the type of counseling provided, who attended the session, and the duration of the session.
When it comes to reimbursing claims, payers and standard coding rules have the “final word” on codes used for a session. If a payer changes the codes used, partially denies a claim, or if a provider uses disallowed codes together, your payout may be recouped.
Most common behavioral health CPT codes
We’ve put together an easy list you can reference to find the most frequently used CPT codes for conducting virtual counseling services.
- 90791 — Integrative Biopsychosocial Assessment
- 90832 — Psychotherapy, 30 minutes with patient
- 90834 — Psychotherapy, 45 minutes with patient
- 90837 — Psychotherapy, 60 minutes with patient
- 90846 — Family psychotherapy (without the patient present), 50 minutes
- 90847 — Family psychotherapy (with patient present), 50 minutes
The APA states, when reporting a psychotherapy service, the provider may apply the CPT “Time Rule,” which means that the provider will choose the code closest to the actual time of the session:
Psychotherapy Session Codes With Time Duration
- 90832 — 16–37 minutes
- 90834 — 38–52 minutes
- 90837 — 53 or more minutes
- 90846, 90847 —26 or more minutes
Certain scenarios may cause an insurance company to request to review treatment notes. You should always include medical necessity for continued care in your clinical notes.
There are certain codes where an insurance company may look for medical necessity in the session notes. These codes include
- Family therapy
- Crisis intervention,
- Adjustment Disorder diagnosis,
- Billing for a 90791 or 90792 (psychiatric diagnostic services without and with medical services, respectively) more than once every 6 months for the same client
Insurance companies also monitor claims closely if a client has more than one counseling session per week. If you have a client who needs multiple sessions during the week, we recommend you contact their insurance first to understand their benefits and possibly gain prior authorization for these services.
What is a CPT code error?
To protect yourself from insurance clawbacks, we encourage you to confirm that all information you submit in your client progress notes is filled out, true, and accurate.
If you're using UpLift, we'll do our best to alert you about errors when we find them and provide guidance where possible to help you move forward better. These could be considered coding errors that we may not be able to protect you from:
- Sessions codes that do not align with CPT, ICD-10, or payer guidelines
- Submitted CPT or diagnosis codes do not represent the service performed or match session notes
- Failure to produce session notes upon request
- Failure to respond to a request for notes within 3 business days
- Failure to respond to a client or UpLift in the event of a late cancellation fee or billing dispute
If you have any questions about coding on UpLift, we can help. You can ask us by emailing email@example.com.