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Transcript
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
80100-80101 [80104]
304.42
80100
Drug screen, qualitative; multiple drug classes chromatographic
method, each procedure
80101
single drug class method (eg, immunoassay, enzyme assay),
each drug class
80104
multiple drug classes other than chromatographic method,
each procedure
Explanation
This test may be requested as a drug screen for multiple drug classes.
The screening test must be performed by a chromatographic technique
that has good sensitivity, although it may not be as specific as a
confirmatory test. Thin-layer chromatography is a common
chromatographic technique for drug screening tests. It is performed
by applying a thin layer adsorbent to a rectangular plate in the
stationary phase. The specimen is applied to the plate and the end of
the plate is placed in a solvent. As the solvent rises along the adsorbent
on the plate, the different components of the specimen are carried
along at varying rates and deposited along the plate. The different
components can be separately visualized and analyzed. Positive tests
are always confirmed with a second method. Specimen type varies.
Coding Tips
Code 80104 is a resequenced code and will not display in numeric
order. Refer to codes in the Chemistry section (82000-84999) or the
Therapeutic Drug Assay section of the CPT book for quantitation of
drugs screened (80150-80299). To report the professional services for
drug management, see HCPCS Level II code M0064, CPT code 90683,
the appropriate level of E/M service, or the appropriate psychotherapy
with E/M service code. Follow third-party payer guidelines when
selecting the appropriate code for these services. If a specimen is
transported to an outside laboratory, report 99000 for handling or
conveyance. These codes represent a CLIA-waived test.
ICD-9-CM Diagnostic Codes
304.00
304.01
304.02
304.10
304.11
304.12
304.20
304.21
304.22
304.30
304.31
304.32
304.40
304.41
Opioid type dependence, unspecified
Opioid type dependence, continuous
Opioid type dependence, episodic
Sedative, hypnotic or anxiolytic dependence, unspecified
Sedative, hypnotic or anxiolytic dependence, continuous
Sedative, hypnotic or anxiolytic dependence, episodic
Cocaine dependence, unspecified
Cocaine dependence, continuous
Cocaine dependence, episodic
Cannabis dependence, unspecified
Cannabis dependence, continuous
Cannabis dependence, episodic
Amphetamine and other psychostimulant dependence,
unspecified
Amphetamine and other psychostimulant dependence,
continuous
Work Value
80100........................ 0.00
80101........................ 0.00
80104........................ 0.00
© 2014 OptumInsight, Inc.
304.51
304.52
304.61
304.62
304.71
304.72
304.81
304.82
305.21
305.22
305.31
305.32
305.41
305.42
305.51
305.52
305.61
305.62
305.71
305.72
305.81
305.82
Amphetamine and other psychostimulant dependence,
episodic
Hallucinogen dependence, continuous
Hallucinogen dependence, episodic
Other specified drug dependence, continuous
Other specified drug dependence, episodic
Combinations of opioid type drug with any other drug
dependence, continuous
Combinations of opioid type drug with any other drug
dependence, episodic
Combinations of drug dependence excluding opioid type
drug, continuous
Combinations of drug dependence excluding opioid type
drug, episodic
Nondependent cannabis abuse, continuous
Nondependent cannabis abuse, episodic
Nondependent hallucinogen abuse, continuous
Nondependent hallucinogen abuse, episodic
Nondependent sedative hypnotic or anxiolytic abuse,
continuous
Nondependent sedative, hypnotic or anxiolytic abuse,
episodic
Nondependent opioid abuse, continuous
Nondependent opioid abuse, episodic
Nondependent cocaine abuse, continuous
Nondependent cocaine abuse, episodic
Nondependent amphetamine or related acting
sympathomimetic abuse, continuous
Nondependent amphetamine or related acting
sympathomimetic abuse, episodic
Nondependent antidepressant type abuse, continuous
Nondependent antidepressant type abuse, episodic
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
IOM References
100-4,16,70.8
CCI Version 20.0
80500-80502
Also not with 80100: 80101, 82486-82489, G0431v
Also not with 80101: 83516-83518, G0431v
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
CPT © 2014 American Medical Association. All Rights Reserved.
87
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
80102
80102
304.70
304.71
Drug confirmation, each procedure
304.72
Explanation
This test may be requested as drug screen confirmation. It is performed
when the initial drug screen (80100-80101) is positive. Confirmatory
tests must be both sensitive and specific and involve a different
technique than the initial screen. For example, if the initial screen is
performed by thin layer chromatography identifying a spot on the
chromatogram that is the right color and in the right place to be
consistent with a particular drug, it is confirmed with a more specific
method, like high performance liquid chromatography (HPLC), gas
chromatography-mass spectrometry (GC-MS), or immunoassay. If the
drug suspected is a barbiturate, for example, a confirmatory HPLC
method might be done to prove that the compound had the correct
retention time, etc., and to identify it exactly as a particular barbiturate.
304.80
304.81
305.21
305.22
305.31
305.32
305.41
Coding Tips
305.42
Refer to codes in the Chemistry section (82000-84999) or the
Therapeutic Drug Assay section of the CPT book for quantitation of
drugs screened (80150-80299). Report 80102 for each procedure
necessary for confirmation. To report the professional services for drug
management, see HCPCS Level II code M0064, CPT code 90863, the
appropriate level of E/M service, or the appropriate psychotherapy with
E/M service code. Follow third-party payer guidelines when selecting
the appropriate code for these services. If a specimen is transported to
an outside laboratory, report 99000 for handling or conveyance.
305.51
305.52
305.61
305.62
305.71
ICD-9-CM Diagnostic Codes
305.81
305.82
304.00
304.01
304.02
304.10
304.11
304.12
304.20
304.21
304.22
304.30
304.31
304.32
304.40
304.41
304.42
304.50
304.51
304.52
Opioid type dependence, unspecified
Opioid type dependence, continuous
Opioid type dependence, episodic
Sedative, hypnotic or anxiolytic dependence, unspecified
Sedative, hypnotic or anxiolytic dependence, continuous
Sedative, hypnotic or anxiolytic dependence, episodic
Cocaine dependence, unspecified
Cocaine dependence, continuous
Cocaine dependence, episodic
Cannabis dependence, unspecified
Cannabis dependence, continuous
Cannabis dependence, episodic
Amphetamine and other psychostimulant dependence,
unspecified
Amphetamine and other psychostimulant dependence,
continuous
Amphetamine and other psychostimulant dependence,
episodic
Hallucinogen dependence, unspecified
Hallucinogen dependence, continuous
Hallucinogen dependence, episodic
Work Value
305.72
Combinations of opioid type drug with any other drug
dependence, unspecified
Combinations of opioid type drug with any other drug
dependence, continuous
Combinations of opioid type drug with any other drug
dependence, episodic
Combinations of drug dependence excluding opioid type
drug, unspecified
Combinations of drug dependence excluding opioid type
drug, continuous
Nondependent cannabis abuse, continuous
Nondependent cannabis abuse, episodic
Nondependent hallucinogen abuse, continuous
Nondependent hallucinogen abuse, episodic
Nondependent sedative hypnotic or anxiolytic abuse,
continuous
Nondependent sedative, hypnotic or anxiolytic abuse,
episodic
Nondependent opioid abuse, continuous
Nondependent opioid abuse, episodic
Nondependent cocaine abuse, continuous
Nondependent cocaine abuse, episodic
Nondependent amphetamine or related acting
sympathomimetic abuse, continuous
Nondependent amphetamine or related acting
sympathomimetic abuse, episodic
Nondependent antidepressant type abuse, continuous
Nondependent antidepressant type abuse, episodic
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
80500-80502
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
80102........................ 0.00
0.00
0.00
0.00
0.00
0.00
88
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
80103
80103
Tissue preparation for drug analysis
Explanation
Tissue is sometimes tested for the presence of drugs. This code reports
the tissue preparation only.
Coding Tips
If a specimen is transported to an outside laboratory, report 99000 for
handling or conveyance. CPT codes 80100–80103 are used to indicate
the qualitative screening of drugs or classes of drugs. Those drugs
commonly assayed include alcohols, amphetamines, barbiturates,
benzodiazepines, cocaine and metabolites, methadones,
methaqualones, opiates, phencylidines, propoxyphenes, phenothiazines,
propoxyphenes, tetrahydrocannabinoids, and tricyclic antidepressants.
Terms To Know
tissue. Group of similar cells with a similar function that form definite structures
and organs. Tissue types include epithelial tissue, muscle tissue, connective
tissue, and nervous tissue.
ICD-9-CM Diagnostic Codes
V70.4
Examination for medicolegal reason — (Use additional
code(s) to identify any special screening examination(s)
performed: V73.0-V82.9)
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
Work Value
80103........................ 0.00
© 2014 OptumInsight, Inc.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.00
0.00
0.00
0.00
0.00
CPT © 2014 American Medical Association. All Rights Reserved.
89
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
80152
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Major depressive disorder, recurrent episode, mild — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Major depressive disorder, recurrent episode, moderate —
(Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Major depressive disorder, recurrent episode, severe,
without mention of psychotic behavior — (Use additional
code to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Major depressive disorder, recurrent episode, severe,
specified as with psychotic behavior — (Use additional
code to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Bipolar I disorder, most recent episode (or current)
depressed, mild — (Use additional code to identify any
associated physical disease, injury, or condition affecting
the brain with psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current)
depressed, moderate — (Use additional code to identify
any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current)
depressed, severe, without mention of psychotic behavior
— (Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current)
depressed, severe, specified as with psychotic behavior —
(Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Poisoning by tricyclic antidepressants
80152
296.31
Amitriptyline
Explanation
Amitriptyline is a tricyclic antidepressant and the prototype brand name
is Elavil. Test specimens are frequently collected at the trough period,
which is about 12 hours after the last dose when serum concentration
is at its lowest. This is an effective approach to determine a therapeutic
level of drug. Drug overdose may be reason for the test as well. Method
is typically high performance liquid chromatography (HPLC) or gas
liquid chromatography (GLC). This drug may be prescribed for disorders
outside of depressive states, such as chronic pain.
296.32
296.33
Coding Tips
This examination is quantitative. For nonquantitative testing, see
80100–80103. To report the professional services for drug management,
see HCPCS Level II code M0064, CPT code 90863, the appropriate
level of E/M service, or the appropriate psychotherapy with E/M service
code. Follow third-party payer guidelines when selecting the appropriate
code for these services. If a specimen is transported to an outside
laboratory, report 99000 for handling or conveyance. Episodic mood
disorders (classified to category 296 in ICD-9-CM) are recurrent, severe
disturbances of mood accompanied by one or more of the following:
delusions, perplexity, disturbed attitude to self, or disorder of perception
and behavior. While subcategories identify the type (e.g., manic or
major depressive, bipolar, etc.) and episodic nature (e.g., single,
recurrent, etc.) of the disorder, the fifth-digit assignment identifies
severity of the episode. Amitriptyline may also be used in the treatment
of pain. ICD-9-CM category 338 Pain, not elsewhere classified, provides
subclassification codes that enable reporting of specific underlying
causes of pain, as well as its acuity or chronicity. Category 338 contains
an instructional note to coders to use an additional code (307.89) to
identify pain associated with psychological factors. It also contains an
exclusions note for generalized and localized pain, as well as pain
disorder exclusively attributed to psychological factors.
296.34
296.51
296.52
296.53
296.54
ICD-9-CM Diagnostic Codes
296.21
296.22
296.23
296.24
Major depressive disorder, single episode, mild — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Major depressive disorder, single episode, moderate —
(Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Major depressive disorder, single episode, severe, without
mention of psychotic behavior — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Major depressive disorder, single episode, severe, specified
as with psychotic behavior — (Use additional code to
Work Value
969.05
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
80152........................ 0.00
0.00
0.00
0.00
0.00
0.00
90
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
80154
80154
293.0
293.1
Benzodiazepines
293.81
Explanation
Benzodiazepines encompass a family of mild sedatives, including
diazepam (Valium) and Ativan. These drugs may be assayed to
determine therapeutic levels, or sometimes to determine levels in the
system following overdose. Test specimens are frequently collected at
the trough period, which is about 12 hours after the last dose when
serum concentration is at its lowest. Method is high performance liquid
chromatography (HPLC), gas liquid chromatography (GLC), or
radioimmunoassay (RIA). This family of drugs may be prescribed for
numerous conditions and disorders. Alcohol withdrawal is a common
use for diazepam, as are muscle spasms.
Coding Tips
Each assay is separately reportable. This code reports quantitative
therapeutic drug assay from any source. For qualitative testing, see CPT
codes 81000-80103. Test assays are frequently collected at peak and
trough periods (i.e., shortly after administration of the drug and
approximately 12 hours after drug administration). If a specimen is
transported to an outside laboratory, report code 99000 for handling
or conveyance.
293.82
293.83
293.84
Delirium due to conditions classified elsewhere — (Code
first the associated physical or neurological condition)
Subacute delirium — (Code first the associated physical or
neurological condition)
Psychotic disorder with delusions in conditions classified
elsewhere — (Code first the associated physical or
neurological condition)
Psychotic disorder with hallucinations in conditions
classified elsewhere — (Code first the associated physical
or neurological condition)
Mood disorder in conditions classified elsewhere — (Code
first the associated physical or neurological condition)
Anxiety disorder in conditions classified elsewhere — (Code
first the associated physical or neurological condition)
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
ICD-9-CM Diagnostic Codes
291.0
291.1
291.2
291.3
291.4
291.5
291.81
291.89
292.0
292.11
292.12
292.2
292.81
292.89
Alcohol withdrawal delirium
Alcohol-induced persisting amnestic disorder
Alcohol-induced persisting dementia
Alcohol-induced psychotic disorder with hallucinations
Idiosyncratic alcohol intoxication
Alcohol-induced psychotic disorder with delusions
Alcohol withdrawal
Other specified alcohol-induced mental disorders
Drug withdrawal — (Use additional code for any associated
drug dependence: 304.0-304.9. Use additional E code to
identify drug)
Drug-induced psychotic disorder with delusions — (Use
additional code for any associated drug dependence:
304.0-304.9. Use additional E code to identify drug)
Drug-induced psychotic disorder with hallucinations —
(Use additional code for any associated drug dependence:
304.0-304.9. Use additional E code to identify drug)
Pathological drug intoxication — (Use additional code for
any associated drug dependence: 304.0-304.9. Use
additional E code to identify drug)
Drug-induced delirium — (Use additional code for any
associated drug dependence: 304.0-304.9. Use additional
E code to identify drug)
Other specified drug-induced mental disorder — (Use
additional code for any associated drug dependence:
304.0-304.9. Use additional E code to identify drug)
Work Value
80154........................ 0.00
© 2014 OptumInsight, Inc.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.00
0.00
0.00
0.00
0.00
CPT © 2014 American Medical Association. All Rights Reserved.
91
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
80155
80155
Caffeine
Explanation
Caffeine is the most widely consumed stimulant in the world and is
found in beverages, foods, and medications. This drug may cause
moderate to severe symptoms and/or caffeine toxicity. Blood specimen
is collected via venipuncture. Test specimens are collected randomly
rather than at trough level. A quantitative analysis of caffeine in the
bloodstream does not influence medical management of the patient.
This test is most commonly used on neonatal patients that are not
responding to caffeine therapy or have suspected toxicity of caffeine.
Method is enzyme immunoassay (EIA).
Coding Tips
This code is new for 2014. This test is quantitative. For nonquantitative
testing, see 80100-80104. If specimen is transported to an outside
laboratory, report 99000 for handling or conveyance.
ICD-9-CM Diagnostic Codes
292.85
785.0
785.1
786.50
969.71
E854.2
E980.3
V72.60
Drug induced sleep disorders — (Use additional code for
any associated drug dependence: 304.0-304.9. Use
additional E code to identify drug)
Unspecified tachycardia
Palpitations
Chest pain, unspecified
Poisoning by caffeine
Accidental poisoning by psychostimulants
Poisoning by tranquilizers and other psychotropic agents,
undetermined whether accidentally or purposely inflicted
Laboratory examination, unspecified
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
Work Value
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
80155........................ 0.00
0.00
0.00
0.00
0.00
0.00
92
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
80156
pain, as well as pain disorder exclusively attributed to psychological
factors.
80156
ICD-9-CM Diagnostic Codes
Carbamazepine; total
296.41
Explanation
This drug, also known as Tegretol, is an enzyme inducer. Blood
specimen collection is by venipuncture. CSF is obtained by spinal
puncture, which is reported separately. Test specimens for total levels
(80156) are frequently collected at the trough period, which is about
12 hours after the last dose when serum concentration is at its lowest.
This is an effective approach to determine a therapeutic level of drug.
Test specimens for free drug concentrations (80157) may be collected
near peak levels about two to eight hours after ingestion. Methods
include high performance liquid chromatography (HPLC) or gas liquid
chromatography (GLC) for both types of analysis. This drug is absorbed
slowly and erratically by the GI tract and a total concentration may be
required, depending on the treatment underway. Methods include
high performance liquid chromatography (HPLC) or gas liquid
chromatography (GLC). Tegretol may be administered for such
conditions as trigeminal neuralgia, epilepsy, and manic disorders. It is
known for its anticonvulsant and pain management properties.
296.42
296.43
296.44
Coding Tips
This examination is quantitative. See 80100-80103 for nonquantitative
testing. To report the professional services for drug management, see
HCPCS Level II code M0064, CPT code 90863, the appropriate level
of E/M service, or the appropriate psychotherapy with E/M service
code. Follow third-party payer guidelines when selecting the appropriate
code for these services. If a specimen is transported to an outside
laboratory, report 99000 for handling or conveyance. Episodic mood
disorders (classified to category 296 in ICD-9-CM) are recurrent, severe
disturbances of mood accompanied by one or more of the following:
delusions, perplexity, disturbed attitude to self, or disorder of perception
and behavior. When coding a bipolar disorder, correct code assignment
is dependent upon the patient's mood. Assign a fourth digit of 0 or 4
when the documentation indicates that the patient is in the manic
phase; characterized by hyperactivity, extreme agitation or exaggerated
excitability, and/or accelerated speech and thought processes. A fourth
digit of 5 should be assigned when the patient is in the depressive
phase. Medical record documentation may indicate that the patient is
exhibiting sadness, low self-esteem, feelings of guilt, interrupted sleep,
or withdrawal from family and/or friends. A bipolar disorder may also
be mixed and documentation indicates that the patient exhibits mood
ranges from manic to depressive. A fourth digit of 6 is reported when
this is documented. A fifth digit must also be assigned indicating the
severity of the disorder when one of these fourth digits is assigned. A
fourth digit of 7 or 8 indicates a bipolar I disorder of unspecified phase
or an unspecified bipolar disorder, respectively. ICD-9-CM code 296.89
is used to report bipolar II disorders. This drug may also be used in the
treatment of pain. ICD-9-CM category 338 Pain, not elsewhere
classified, provides subclassification codes that enable reporting of
specific underlying causes of pain, as well as its acuity or chronicity.
Category 338 contains an instructional note to coders to use an
additional code (307.89) to identify pain associated with psychological
factors. It also contains an exclusions note for generalized and localized
Work Value
80156........................ 0.00
© 2014 OptumInsight, Inc.
296.61
296.62
296.63
296.64
Bipolar I disorder, most recent episode (or current) manic,
mild — (Use additional code to identify any associated
physical disease, injury, or condition affecting the brain
with psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current) manic,
moderate — (Use additional code to identify any associated
physical disease, injury, or condition affecting the brain
with psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current) manic,
severe, without mention of psychotic behavior — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Bipolar I disorder, most recent episode (or current) manic,
severe, specified as with psychotic behavior — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Bipolar I disorder, most recent episode (or current) mixed,
mild — (Use additional code to identify any associated
physical disease, injury, or condition affecting the brain
with psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current) mixed,
moderate — (Use additional code to identify any associated
physical disease, injury, or condition affecting the brain
with psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current) mixed,
severe, without mention of psychotic behavior — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Bipolar I disorder, most recent episode (or current) mixed,
severe, specified as with psychotic behavior — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.00
0.00
0.00
0.00
0.00
CPT © 2014 American Medical Association. All Rights Reserved.
93
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
80159
associated physical disease, injury, or condition affecting
the brain with psychoses classifiable to 295-298)
Simple schizophrenia, chronic condition with acute
exacerbation — (Use additional code to identify any
associated physical disease, injury, or condition affecting
the brain with psychoses classifiable to 295-298)
Simple schizophrenia, in remission — (Use additional code
to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Disorganized schizophrenia, subchronic condition — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Disorganized schizophrenia, chronic condition — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Disorganized schizophrenia, subchronic condition with
acute exacerbation — (Use additional code to identify any
associated physical disease, injury, or condition affecting
the brain with psychoses classifiable to 295-298)
Disorganized schizophrenia, chronic condition with acute
exacerbation — (Use additional code to identify any
associated physical disease, injury, or condition affecting
the brain with psychoses classifiable to 295-298)
Disorganized schizophrenia, in remission — (Use additional
code to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Poisoning by other antipsychotics, neuroleptics, and major
tranquilizers — (Use additional code to specify the effects
of poisoning)
Accidental poisoning by other specified tranquilizers
Other antipsychotics, neuroleptics, and major tranquilizers
causing adverse effect in therapeutic use
Suicide and self-inflicted poisoning by tranquilizers and
other psychotropic agents
Poisoning by tranquilizers and other psychotropic agents,
undetermined whether accidentally or purposely inflicted
Laboratory examination, unspecified
80159
295.04
Clozapine
Explanation
This drug, also known as Clozaril, is an atypical antipsychotic used to
treat severe cases of schizophrenia in which the patient is a threat to
themselves and/or others. It changes the activity of certain chemical
processes in the brain. Agranulocytosis is the most common side effect
and therefore white blood cell and absolute neutrophil count are
required weekly for the first six months, biweekly for the second six
months, and every four weeks after a year of being maintained on
clozapine. Blood specimen is collected by venipuncture usually during
the trough period. Methods include liquid chromatography and tandem
mass spectrometry.
295.05
295.11
295.12
Coding Tips
This code is new for 2014. This test is quantitative. To report
nonquantitative testing, see 80100-80104. If specimen is transported
to an outside laboratory, report 99000 for handling or conveyance.
Schizophrenia is not diagnosed unless there is characteristic disturbance
of at least two of these areas: thought, perception, mood, conduct,
and personality. The first axis of coding schizophrenia is to identify the
type (e.g., simple, disordered, paranoid, latent, residual, etc.). Identify
the course of illness with a fifth digit, as follows: 0 Unspecified, 1
Subchronic state: continuous for more than six months but less than
two years, 2 Chronic state: continuous for more than two years, 3
Subchronic with acute exacerbation: continuous for more than six
months but less than two years but psychotic features have resurfaced
in patient who has been in residual phase, 4 Chronic with acute
exacerbation: continuous for more than two years but psychotic features
have resurfaced in patient who has been in residual phase and, 5 In
remission: history of schizophrenia but free from symptoms, regardless
of whether patient is currently on medication. When the medical record
documentation indicates that the patient suffered an overdose of the
drug, either accidental or as a suicide attempt, see the Table of Drugs
and Chemicals to locate the appropriate external cause (E) code.
ICD-9-CM Diagnostic Codes
295.00
295.01
295.02
295.03
Simple schizophrenia, unspecified condition — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Simple schizophrenia, subchronic condition — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Simple schizophrenia, chronic condition — (Use additional
code to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Simple schizophrenia, subchronic condition with acute
exacerbation — (Use additional code to identify any
Work Value
295.13
295.14
295.15
969.3
E853.8
E939.3
E950.3
E980.3
V72.60
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
80159........................ 0.00
0.00
0.00
0.00
0.00
0.00
94
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
80160
80160
296.32
Desipramine
296.33
Explanation
This drug is also known as Norpramin and is among the tricyclic
antidepressants. Steady state test specimens are frequently collected
at the trough period, which is about 12 hours after the last dose when
serum concentration is at its lowest. This is an effective approach to
determine a therapeutic level of drug. Overdose is also a reason to run
this test. Method is high performance liquid chromatography (HPLC)
or gas liquid chromatography (GLC).
296.34
Coding Tips
For nonquantitative testing, see 80100–80103. To report the
professional services for drug management, see HCPCS Level II code
M0064, CPT code 90863, the appropriate level of E/M service, or the
appropriate psychotherapy with E/M service code. Follow third-party
payer guidelines when selecting the appropriate code for these services.
Episodic mood disorders (classified to category 296 in ICD-9-CM) are
recurrent, severe disturbances of mood accompanied by one or more
of the following: delusions, perplexity, disturbed attitude to self, or
disorder of perception and behavior. While subcategories identify the
type (e.g., manic or major depressive, bipolar, etc.) and episodic nature
(e.g., single, recurrent, etc.) of the disorder, the fifth-digit assignment
identifies severity of the episode.
296.36
296.52
296.53
ICD-9-CM Diagnostic Codes
296.21
296.22
296.23
296.24
296.26
296.31
Major depressive disorder, single episode, mild — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Major depressive disorder, single episode, moderate —
(Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Major depressive disorder, single episode, severe, without
mention of psychotic behavior — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Major depressive disorder, single episode, severe, specified
as with psychotic behavior — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Major depressive disorder, single episode in full remission
— (Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Major depressive disorder, recurrent episode, mild — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Work Value
80160........................ 0.00
© 2014 OptumInsight, Inc.
296.54
296.56
300.3
300.4
Major depressive disorder, recurrent episode, moderate —
(Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Major depressive disorder, recurrent episode, severe,
without mention of psychotic behavior — (Use additional
code to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Major depressive disorder, recurrent episode, severe,
specified as with psychotic behavior — (Use additional
code to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Major depressive disorder, recurrent episode, in full
remission — (Use additional code to identify any associated
physical disease, injury, or condition affecting the brain
with psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current)
depressed, moderate — (Use additional code to identify
any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current)
depressed, severe, without mention of psychotic behavior
— (Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current)
depressed, severe, specified as with psychotic behavior —
(Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current)
depressed, in full remission — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Obsessive-compulsive disorders
Dysthymic disorder
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.00
0.00
0.00
0.00
0.00
CPT © 2014 American Medical Association. All Rights Reserved.
95
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
80164
80164
296.01
Dipropylacetic acid (valproic acid)
Explanation
296.02
This drug is also known as Depakene. This drug is often used to treat
seizures. Test specimens are frequently collected at the trough period,
which is about 12 hours after the last dose when serum concentration
is at its lowest. This is an effective approach to determine a therapeutic
level of drug. Method is gas liquid chromatography (GLC), gas
chromatography-mass spectrometry (GC-MS), and enzyme
immunoassay (EIA).
296.03
296.04
Coding Tips
This examination is quantitative. For nonquantitative testing, see
80100–80103. To report the professional services for drug management,
see HCPCS Level II code M0064, CPT code 90863, the appropriate
level of E/M service, or the appropriate psychotherapy with E/M service
code. Follow third-party payer guidelines when selecting the appropriate
code for these services. If a specimen is transported to an outside
laboratory, report 99000 for handling or conveyance. Epilepsy is a
disorder characterized by recurrent transient disturbances of the cerebral
function. An abnormal paroxysmal neuronal discharge in the brain
usually results in convulsive seizures, but may result in loss of
consciousness, abnormal behavior, and sensory disturbances in any
combination. Epilepsy may be secondary to prior trauma, hemorrhage,
intoxication (toxins), chemical imbalances, anoxia, infections,
neoplasms, or congenital defects. The ICD-9-CM alphabetic index
provides guidance regarding appropriate code assignment for single,
recurrent or repetitive seizures and seizure disorder. Accordingly, a
single seizure is reported with code 780.39. Recurrent or repetitive
seizures are reported with code 345.9x Epilepsy, unspecified. Report
code 345.9x Epilepsy, unspecified, for seizure disorder, not otherwise
specified, and recurrent seizures. While subcategories identify the
specific type of seizure, fifth-digit assignment identifies if intractable
epilepsy is present: 0 Without mention of intractable epilepsy, 1 With
intractable epilepsy.
Terms To Know
bipolar disorder. Manic-depressive psychosis that has appeared in both the
depressive and manic form, either alternating or separated by an interval of
normality. Atypical: Episode of affective psychosis with some, but not all, of
the features of the one form of the disorder in individuals who have had a
previous episode of the other form of the disorder.
intractable. Resistant to relief.
status epilepticus. More than 30 minutes of continuous seizure or multiple
sequential seizures without a return to consciousness in between. Treatment
usually begins after five minutes of seizure activity.
ICD-9-CM Diagnostic Codes
296.00
296.40
296.41
296.42
296.43
296.44
Bipolar I disorder, single manic episode, mild — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Bipolar I disorder, single manic episode, moderate — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Bipolar I disorder, single manic episode, severe, without
mention of psychotic behavior — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Bipolar I disorder, single manic episode, severe, specified
as with psychotic behavior — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current) manic,
unspecified — (Use additional code to identify any
associated physical disease, injury, or condition affecting
the brain with psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current) manic,
mild — (Use additional code to identify any associated
physical disease, injury, or condition affecting the brain
with psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current) manic,
moderate — (Use additional code to identify any associated
physical disease, injury, or condition affecting the brain
with psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current) manic,
severe, without mention of psychotic behavior — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Bipolar I disorder, most recent episode (or current) manic,
severe, specified as with psychotic behavior — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
Bipolar I disorder, single manic episode, unspecified —
(Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Work Value
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
80164........................ 0.00
0.00
0.00
0.00
0.00
0.00
96
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
80166
80166
296.32
Doxepin
Explanation
296.33
This drug is also known as Sinequan or Adapin. This drug is classified
as a tricyclic antidepressant (TCA). Steady state test specimens are
frequently collected at the trough period, which is about 12 hours after
the last dose when serum concentration is at its lowest. This is an
effective approach to determine a therapeutic level of drug. Overdose
may also prompt this test. Method is high performance liquid
chromatography (HPLC), gas liquid chromatography (GLC), gas
chromatography-mass spectrometry (GC-MS), and radioimmunoassay
(RIA).
296.34
296.36
Coding Tips
This examination is quantitative. For nonquantitative testing, see
80100–80103. To report the professional services for drug management,
see HCPCS Level II code M0064, CPT code 90863, the appropriate
level of E/M service, or the appropriate psychotherapy with E/M service
code. Follow third-party payer guidelines when selecting the appropriate
code for these services. If a specimen is transported to an outside
laboratory, report 99000 for handling or conveyance. Episodic mood
disorders (classified to category 296 in ICD-9-CM) are recurrent, severe
disturbances of mood accompanied by one or more of the following:
delusions, perplexity, disturbed attitude to self, or disorder of perception
and behavior. While subcategories identify the type (e.g., manic or
major depressive, bipolar, etc.) and episodic nature (e.g., single,
recurrent, etc.) of the disorder, the fifth-digit assignment identifies
severity of the episode.
296.51
296.52
296.53
ICD-9-CM Diagnostic Codes
296.22
296.23
296.24
296.26
296.31
Major depressive disorder, single episode, moderate —
(Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Major depressive disorder, single episode, severe, without
mention of psychotic behavior — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Major depressive disorder, single episode, severe, specified
as with psychotic behavior — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Major depressive disorder, single episode in full remission
— (Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Major depressive disorder, recurrent episode, mild — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Work Value
80166........................ 0.00
© 2014 OptumInsight, Inc.
296.54
296.56
Major depressive disorder, recurrent episode, moderate —
(Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Major depressive disorder, recurrent episode, severe,
without mention of psychotic behavior — (Use additional
code to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Major depressive disorder, recurrent episode, severe,
specified as with psychotic behavior — (Use additional
code to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Major depressive disorder, recurrent episode, in full
remission — (Use additional code to identify any associated
physical disease, injury, or condition affecting the brain
with psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current)
depressed, mild — (Use additional code to identify any
associated physical disease, injury, or condition affecting
the brain with psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current)
depressed, moderate — (Use additional code to identify
any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current)
depressed, severe, without mention of psychotic behavior
— (Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current)
depressed, severe, specified as with psychotic behavior —
(Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current)
depressed, in full remission — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.00
0.00
0.00
0.00
0.00
CPT © 2014 American Medical Association. All Rights Reserved.
97
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
80173
80173
295.31
Haloperidol
Explanation
295.32
This drug, also known as Haldol, is a well-established tranquilizer with
antipsychotic and other properties. Blood concentrations of haloperidol
do not correspond well with therapeutic dosages; therefore, assays may
be performed to establish compliance or to measure the body's ability
to metabolize the drug. Methods may include high performance liquid
chromatography (HPLC), gas liquid chromatography (GLC), and
radioimmunoassay (RIA).
295.41
295.42
Coding Tips
This examination is quantitative. See 80100–80103 for nonquantitative
testing. If a specimen is transported to an outside laboratory, report
99000 for handling or conveyance. To report the professional services
for drug management, see HCPCS Level II code M0064, CPT code
90863, the appropriate level of E/M service, or the appropriate
psychotherapy with E/M service code. Follow third-party payer
guidelines when selecting the appropriate code for these services.
Schizophrenia is not diagnosed unless there is characteristic disturbance
of at least two of these areas: thought, perception, mood, conduct,
and personality. The first axis of coding schizophrenia is to identify the
type (e.g., simple, disordered, paranoid, latent, residual, etc.). Identify
the course of illness with a fifth-digit, as follows: 0 Unspecified, 1
Subchronic state: continuous for more than six months but less than
two years, 2 Chronic state: continuous for more than two years, 3
Subchronic with acute exacerbation: continuous for more than six
months but less than two years but psychotic features have resurfaced
in patient who has been in residual phase, 4 Chronic with acute
exacerbation: continuous for more than two years but psychotic features
have resurfaced in patient who has been in residual phase, and 5 In
remission: history of schizophrenia but free from symptoms, regardless
of whether patient is currently on medication.
295.51
295.52
295.61
295.62
295.71
ICD-9-CM Diagnostic Codes
295.01
295.02
295.11
295.12
Simple schizophrenia, subchronic condition — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Simple schizophrenia, chronic condition — (Use additional
code to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Disorganized schizophrenia, subchronic condition — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Disorganized schizophrenia, chronic condition — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Work Value
295.72
Paranoid schizophrenia, subchronic condition — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Paranoid schizophrenia, chronic condition — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Schizophreniform disorder, subchronic — (Use additional
code to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Schizophreniform disorder, chronic — (Use additional code
to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Latent schizophrenia, subchronic condition — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Latent schizophrenia, chronic condition — (Use additional
code to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Schizophrenic disorders, residual type, subchronic — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Schizophrenic disorders, residual type, chronic — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Schizoaffective disorder, subchronic — (Use additional
code to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Schizoaffective disorder, chronic — (Use additional code
to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
80173........................ 0.00
0.00
0.00
0.00
0.00
0.00
98
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
80174
80174
296.33
Imipramine
Explanation
This drug may also be known as Tofranil. The drug is classified as a
tricyclic antidepressant (TCA). Steady state test specimens are frequently
collected at the trough period, which is about 12 hours after the last
dose when serum concentration is at its lowest. This is an effective
approach to determine a therapeutic level of drug. Overdose may also
prompt this test. Method is high performance liquid chromatography
(HPLC), gas liquid chromatography (GLC), gas chromatography-mass
spectrometry (GC-MS), and radioimmunoassay (RIA).
Coding Tips
This examination is quantitative. For nonquantitative testing, see
80100–80103. To report the professional services for drug management,
see HCPCS Level II code M0064, CPT code 90863, the appropriate
level of E/M service, or the appropriate psychotherapy with E/M service
code. Follow third-party payer guidelines when selecting the appropriate
code for these services. Episodic mood disorders (classified to category
296 in ICD-9-CM) are recurrent, severe disturbances of mood
accompanied by one or more of the following: delusions, perplexity,
disturbed attitude to self, disorder of perception and behavior. While
subcategories identify the type (e.g., manic or major depressive, bipolar,
etc.) and episodic nature (e.g., single, recurrent, etc.) of the disorder,
the fifth-digit assignment identifies severity of the episode.
296.34
296.51
296.52
296.53
296.54
ICD-9-CM Diagnostic Codes
296.21
296.22
296.23
296.24
296.26
296.32
Major depressive disorder, single episode, mild — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Major depressive disorder, single episode, moderate —
(Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Major depressive disorder, single episode, severe, without
mention of psychotic behavior — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Major depressive disorder, single episode, severe, specified
as with psychotic behavior — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Major depressive disorder, single episode in full remission
— (Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Major depressive disorder, recurrent episode, moderate —
(Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Work Value
80174........................ 0.00
© 2014 OptumInsight, Inc.
296.56
296.82
300.4
969.05
Major depressive disorder, recurrent episode, severe,
without mention of psychotic behavior — (Use additional
code to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Major depressive disorder, recurrent episode, severe,
specified as with psychotic behavior — (Use additional
code to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Bipolar I disorder, most recent episode (or current)
depressed, mild — (Use additional code to identify any
associated physical disease, injury, or condition affecting
the brain with psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current)
depressed, moderate — (Use additional code to identify
any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current)
depressed, severe, without mention of psychotic behavior
— (Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current)
depressed, severe, specified as with psychotic behavior —
(Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current)
depressed, in full remission — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Atypical depressive disorder — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Dysthymic disorder
Poisoning by tricyclic antidepressants
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.00
0.00
0.00
0.00
0.00
CPT © 2014 American Medical Association. All Rights Reserved.
99
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
80178
80178
296.34
Lithium
Explanation
This drug may also be known as Eskalith. Lithium is a naturally occurring
mineral and its salts may be used in the treatment of mental disorders,
in particular bipolar depression. Steady state test specimens are
frequently collected at the trough period, which is about 12 hours after
the last dose when serum concentration is at its lowest. This is an
effective approach to determine a therapeutic level of drug. Methods
may include flame emission spectroscopy (FES), atomic absorption
spectrophotometry (AAS), and ion-specific electrode (ISE).
This examination is quantitative. See 80100–80103 for nonquantitative
testing. To report the professional services for drug management, see
HCPCS Level II code M0064, CPT code 90863, the appropriate level
of E/M service, or the appropriate psychotherapy with E/M service
code. Follow third-party payer guidelines when selecting the appropriate
code for these services. If a specimen is transported to an outside
laboratory, report 99000 for handling or conveyance.
296.24
296.25
296.26
296.31
296.32
Major depressive disorder, single episode, mild — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Major depressive disorder, single episode, moderate —
(Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Major depressive disorder, single episode, severe, specified
as with psychotic behavior — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Major depressive disorder, single episode, in partial or
unspecified remission — (Use additional code to identify
any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Major depressive disorder, single episode in full remission
— (Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Major depressive disorder, recurrent episode, mild — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Major depressive disorder, recurrent episode, moderate —
(Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Work Value
296.52
296.54
ICD-9-CM Diagnostic Codes
296.22
296.36
296.51
Coding Tips
296.21
296.35
296.55
296.56
296.82
Major depressive disorder, recurrent episode, severe,
specified as with psychotic behavior — (Use additional
code to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Major depressive disorder, recurrent episode, in partial or
unspecified remission — (Use additional code to identify
any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Major depressive disorder, recurrent episode, in full
remission — (Use additional code to identify any associated
physical disease, injury, or condition affecting the brain
with psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current)
depressed, mild — (Use additional code to identify any
associated physical disease, injury, or condition affecting
the brain with psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current)
depressed, moderate — (Use additional code to identify
any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current)
depressed, severe, specified as with psychotic behavior —
(Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current)
depressed, in partial or unspecified remission — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Bipolar I disorder, most recent episode (or current)
depressed, in full remission — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Atypical depressive disorder — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
80178........................ 0.00
0.00
0.00
0.00
0.00
0.00
100
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
80182
80182
296.25
Nortriptyline
Explanation
This drug may also be known as Aventyl or Pamelor. This drug is
classified as a tricyclic antidepressant (TCA). Steady state test specimens
are frequently collected at the trough period, which is about 12 hours
after the last dose when serum concentration is at its lowest. This is an
effective approach to determine a therapeutic level of drug. Overdose
may also prompt this test. Any of a number of methods may be used,
including high performance liquid chromatography (HPLC), gas liquid
chromatography (GLC), and gas chromatography-mass spectrometry
(GC-MS).
This examination is quantitative. See 80100–80103 for nonquantitative
testing. To report the professional services for drug management, see
HCPCS Level II code M0064, CPT code 90863, the appropriate level
of E/M service, or the appropriate psychotherapy with E/M service
code. Follow third-party payer guidelines when selecting the appropriate
code for these services. If a specimen is transported to an outside
laboratory, report 99000 for handling or conveyance. Episodic mood
disorders (classified to category 296 in ICD-9-CM) are recurrent, severe
disturbances of mood accompanied by one or more of the following:
delusions, perplexity, disturbed attitude to self, or disorder of perception
and behavior. While subcategories identify the type (e.g., manic or
major depressive, bipolar, etc.) and episodic nature (e.g., single,
recurrent, etc.) of the disorder, the fifth-digit assignment identifies
severity of the episode: 0 Unspecified, 1 Mild, 2 Moderate, 3 Severe,
without mention of psychotic behavior, 4 Severe, specified as with
psychotic behavior, 5 In partial or unspecified remission, and 6 In full
remission.
296.22
296.23
296.24
Major depressive disorder, single episode, unspecified —
(Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Major depressive disorder, single episode, mild — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Major depressive disorder, single episode, moderate —
(Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Major depressive disorder, single episode, severe, without
mention of psychotic behavior — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Major depressive disorder, single episode, severe, specified
as with psychotic behavior — (Use additional code to
Work Value
80182........................ 0.00
© 2014 OptumInsight, Inc.
296.33
296.50
296.51
296.52
ICD-9-CM Diagnostic Codes
296.21
296.31
296.32
Coding Tips
296.20
296.30
296.82
969.05
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Major depressive disorder, single episode, in partial or
unspecified remission — (Use additional code to identify
any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Major depressive disorder, recurrent episode, unspecified
— (Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Major depressive disorder, recurrent episode, mild — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Major depressive disorder, recurrent episode, moderate —
(Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Major depressive disorder, recurrent episode, severe,
without mention of psychotic behavior — (Use additional
code to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Bipolar I disorder, most recent episode (or current)
depressed, unspecified — (Use additional code to identify
any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current)
depressed, mild — (Use additional code to identify any
associated physical disease, injury, or condition affecting
the brain with psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current)
depressed, moderate — (Use additional code to identify
any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Atypical depressive disorder — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Poisoning by tricyclic antidepressants
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.00
0.00
0.00
0.00
0.00
CPT © 2014 American Medical Association. All Rights Reserved.
101
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
80183
any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Bipolar I disorder, single manic episode, in full remission
— (Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Manic disorder, recurrent episode, unspecified — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Manic disorder, recurrent episode, mild — (Use additional
code to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Manic disorder, recurrent episode, moderate — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Manic disorder, recurrent episode, severe, without mention
of psychotic behavior — (Use additional code to identify
any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Manic disorder, recurrent episode, severe, specified as with
psychotic behavior — (Use additional code to identify any
associated physical disease, injury, or condition affecting
the brain with psychoses classifiable to 295-298)
Laboratory examination, unspecified
80183
296.06
Oxcarbazepine
Explanation
Oxcarbazepine is also known as Trileptal and is an anticonvulsant and
mood stabilizer used to treat epilepsy, motor tics, bipolar disorder, and
anxiety. Test specimen is blood collected via venipuncture. This is an
effective approach to determine a therapeutic level. Methods include
tandem mass spectrometry or liquid chromatography.
296.11
Coding Tips
This code is new for 2014. It is for quantitative testing. For
nonquantiative testing see 80100-80104. If specimen is transported to
an outside laboratory, report 99000 for handling or conveyance.
Schizophrenia is not diagnosed unless there is characteristic disturbance
of at least two of these areas: thought, perception, mood, conduct,
and personality. The first axis of coding schizophrenia is to identify the
type (e.g., simple, disordered, paranoid, latent, residual, etc.). Identify
the course of illness with a fifth digit, as follows: 0 Unspecified, 1
Subchronic state: continuous for more than six months but less than
two years, 2 Chronic state: continuous for more than two years, 3
Subchronic with acute exacerbation: continuous for more than six
months but less than two years but psychotic features have resurfaced
in patient who has been in residual phase, 4 Chronic with acute
exacerbation: continuous for more than two years but psychotic features
have resurfaced in patient who has been in residual phase and, 5 In
remission: history of schizophrenia but free from symptoms, regardless
of whether patient is currently on medication. When the medical record
documentation indicates that the patient suffered an overdose of the
drug, either accidental or as a suicide attempt, see the Table of Drugs
and Chemicals to locate the appropriate external cause (E) code.</
ICD-9-CM Diagnostic Codes
296.01
296.02
296.03
296.04
296.05
296.10
Bipolar I disorder, single manic episode, mild — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Bipolar I disorder, single manic episode, moderate — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Bipolar I disorder, single manic episode, severe, without
mention of psychotic behavior — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Bipolar I disorder, single manic episode, severe, specified
as with psychotic behavior — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Bipolar I disorder, single manic episode, in partial or
unspecified remission — (Use additional code to identify
Work Value
296.12
296.13
296.14
V72.60
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
80183........................ 0.00
0.00
0.00
0.00
0.00
0.00
102
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
80184
80184
345.41
Phenobarbital
345.50
Explanation
This drug may also be known as Luminal. This drug may be
administered to control seizures. Test specimens are frequently collected
at the trough period, which is about 12 hours after the last dose when
serum concentration is at its lowest. This is an effective approach to
determine a therapeutic level of drug. Methodology may include gas
liquid chromatography (GLC) and high performance liquid
chromatography (HPLC).
Coding Tips
This examination is quantitative. See 80100–80103 for nonquantitative
testing. To report the professional services for drug management, see
HCPCS Level II code M0064, CPT code 90863, the appropriate level
of E/M service, or the appropriate psychotherapy with E/M service
code. Follow third-party payer guidelines when selecting the appropriate
code for these services. If a specimen is transported to an outside
laboratory, report 99000 for handling or conveyance. The ICD-9-CM
alphabetic index provides guidance regarding appropriate code
assignment for single, recurrent or repetitive seizures and seizure
disorder. Accordingly, a single seizure is reported with code 780.39.
Recurrent or repetitive seizures are reported with code 345.9x Epilepsy,
unspecified. Report code 345.9x Epilepsy, unspecified, for seizure
disorder, not otherwise specified, and recurrent seizures. While
subcategories identify the specific type of seizure, fifth-digit assignment
identifies if intractable epilepsy is present: 0 Without mention of
intractable epilepsy, 1 With intractable epilepsy.
345.51
345.70
345.71
345.80
345.81
345.90
345.91
780.33
780.39
Localization-related (focal) (partial) epilepsy and epileptic
syndromes with complex partial seizures, with intractable
epilepsy
Localization-related (focal) (partial) epilepsy and epileptic
syndromes with simple partial seizures, without mention
of intractable epilepsy
Localization-related (focal) (partial) epilepsy and epileptic
syndromes with simple partial seizures, with intractable
epilepsy
Epilepsia partialis continua without mention of intractable
epilepsy
Epilepsia partialis continua with intractable epilepsy
Other forms of epilepsy and recurrent seizures, without
mention of intractable epilepsy
Other forms of epilepsy and recurrent seizures, with
intractable epilepsy
Unspecified epilepsy without mention of intractable
epilepsy
Unspecified epilepsy with intractable epilepsy
Post traumatic seizures
Other convulsions
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
Terms To Know
specimen. Tissue cells or sample of fluid taken for analysis, pathologic
examination, and diagnosis.
therapeutic. Act meant to alleviate a medical or mental condition.
venipuncture. Piercing a vein through the skin by a needle and syringe or
sharp-ended cannula or catheter to draw blood, start an intravenous infusion,
instill medication, or inject another substance such as radiopaque dye.
ICD-9-CM Diagnostic Codes
345.00
345.01
345.10
345.11
345.2
345.3
345.40
Generalized nonconvulsive epilepsy without mention of
intractable epilepsy
Generalized nonconvulsive epilepsy with intractable
epilepsy
Generalized convulsive epilepsy without mention of
intractable epilepsy
Generalized convulsive epilepsy with intractable epilepsy
Epileptic petit mal status
Epileptic grand mal status
Localization-related (focal) (partial) epilepsy and epileptic
syndromes with complex partial seizures, without mention
of intractable epilepsy
Work Value
80184........................ 0.00
© 2014 OptumInsight, Inc.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.00
0.00
0.00
0.00
0.00
CPT © 2014 American Medical Association. All Rights Reserved.
103
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
80185-80186
80185
80186
345.40
Phenytoin; total
345.41
free
Explanation
This drug may also be known as Dilantin. This drug may be administered
to control seizures. Steady state test specimens are frequently collected
at the trough period, which is about 12 hours after the last dose when
serum concentration is at its lowest. This is an effective approach to
determine a therapeutic level of drug. Report 80185 for total serum
levels and 80186 when free phenytoin is assayed. Methodology may
include high performance liquid chromatography (HPLC), gas liquid
chromatography (GLC), radioimmunoassay (RIA), and fluorescence
polarization immunoassay (FPIA). Free phenytoin is assayed by
ultracentrifugation. Phenytoin is a known teratogen (cause of birth
defects) and lowest therapeutic levels possible are often sought.
Coding Tips
345.50
345.51
345.70
345.71
345.80
345.81
This examination is quantitative. See 80100–80103 for nonquantitative
testing. To report the professional services for drug management, see
HCPCS Level II code M0064, CPT code 90863, the appropriate level
of E/M service, or the appropriate psychotherapy with E/M service
code. Follow third-party payer guidelines when selecting the appropriate
code for these services. If a specimen is transported to an outside
laboratory, report 99000 for handling or conveyance. The ICD-9-CM
alphabetic index provides guidance regarding appropriate code
assignment for single, recurrent or repetitive seizures and seizure
disorder. Accordingly, a single seizure is reported with code 780.39.
Recurrent or repetitive seizures are reported with code 345.9x Epilepsy,
unspecified. Report code 345.9x Epilepsy, unspecified, for seizure
disorder, not otherwise specified, and recurrent seizures. While
subcategories identify the specific type of seizure, fifth-digit assignment
identifies if intractable epilepsy is present: 0 Without mention of
intractable epilepsy, 1 With intractable epilepsy.
345.90
345.91
780.39
Localization-related (focal) (partial) epilepsy and epileptic
syndromes with complex partial seizures, without mention
of intractable epilepsy
Localization-related (focal) (partial) epilepsy and epileptic
syndromes with complex partial seizures, with intractable
epilepsy
Localization-related (focal) (partial) epilepsy and epileptic
syndromes with simple partial seizures, without mention
of intractable epilepsy
Localization-related (focal) (partial) epilepsy and epileptic
syndromes with simple partial seizures, with intractable
epilepsy
Epilepsia partialis continua without mention of intractable
epilepsy
Epilepsia partialis continua with intractable epilepsy
Other forms of epilepsy and recurrent seizures, without
mention of intractable epilepsy
Other forms of epilepsy and recurrent seizures, with
intractable epilepsy
Unspecified epilepsy without mention of intractable
epilepsy
Unspecified epilepsy with intractable epilepsy
Other convulsions
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
Terms To Know
assay. Test of purity.
teratogen. Substance, including radiation and chemicals, that causes aberrant
development in an embryo or fetus.
ICD-9-CM Diagnostic Codes
345.00
345.01
345.10
345.11
345.2
345.3
Generalized nonconvulsive epilepsy without mention of
intractable epilepsy
Generalized nonconvulsive epilepsy with intractable
epilepsy
Generalized convulsive epilepsy without mention of
intractable epilepsy
Generalized convulsive epilepsy with intractable epilepsy
Epileptic petit mal status
Epileptic grand mal status
Work Value
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
80185........................ 0.00
80186........................ 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
104
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
80188
80188
345.41
Primidone
345.50
Explanation
This drug may also be known as Mysoline. This drug may be
administered to control seizures. Test specimens are frequently collected
at the trough period, which is about 12 hours after the last dose when
serum concentration is at its lowest. This is an effective approach to
determine a therapeutic level of drug. Methodology may include high
performance liquid chromatography (HPLC), gas liquid chromatography
(GLC), or enzyme immunoassay (EIA).
Coding Tips
This examination is quantitative. See 80100–80103 for nonquantitative
testing. To report the professional services for drug management, see
HCPCS Level II code M0064, CPT code 90863, the appropriate level
of E/M service, or the appropriate psychotherapy with E/M service
code. Follow third-party payer guidelines when selecting the appropriate
code for these services. If a specimen is transported to an outside
laboratory, report 99000 for handling or conveyance. The ICD-9-CM
alphabetic index provides guidance regarding appropriate code
assignment for single, recurrent or repetitive seizures and seizure
disorder. Accordingly, a single seizure is reported with code 780.39.
Recurrent or repetitive seizures are reported with code 345.9x Epilepsy,
unspecified. Report code 345.9x Epilepsy, unspecified, for seizure
disorder, not otherwise specified, and recurrent seizures. While
subcategories identify the specific type of seizure, fifth-digit assignment
identifies if intractable epilepsy is present: 0 Without mention of
intractable epilepsy, 1 With intractable epilepsy.
345.51
345.70
345.71
345.80
345.81
345.90
345.91
780.33
780.39
Localization-related (focal) (partial) epilepsy and epileptic
syndromes with complex partial seizures, with intractable
epilepsy
Localization-related (focal) (partial) epilepsy and epileptic
syndromes with simple partial seizures, without mention
of intractable epilepsy
Localization-related (focal) (partial) epilepsy and epileptic
syndromes with simple partial seizures, with intractable
epilepsy
Epilepsia partialis continua without mention of intractable
epilepsy
Epilepsia partialis continua with intractable epilepsy
Other forms of epilepsy and recurrent seizures, without
mention of intractable epilepsy
Other forms of epilepsy and recurrent seizures, with
intractable epilepsy
Unspecified epilepsy without mention of intractable
epilepsy
Unspecified epilepsy with intractable epilepsy
Post traumatic seizures
Other convulsions
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
Terms To Know
specimen. Tissue cells or sample of fluid taken for analysis, pathologic
examination, and diagnosis.
therapeutic. Act meant to alleviate a medical or mental condition.
venipuncture. Piercing a vein through the skin by a needle and syringe or
sharp-ended cannula or catheter to draw blood, start an intravenous infusion,
instill medication, or inject another substance such as radiopaque dye.
ICD-9-CM Diagnostic Codes
345.00
345.01
345.10
345.11
345.2
345.3
345.40
Generalized nonconvulsive epilepsy without mention of
intractable epilepsy
Generalized nonconvulsive epilepsy with intractable
epilepsy
Generalized convulsive epilepsy without mention of
intractable epilepsy
Generalized convulsive epilepsy with intractable epilepsy
Epileptic petit mal status
Epileptic grand mal status
Localization-related (focal) (partial) epilepsy and epileptic
syndromes with complex partial seizures, without mention
of intractable epilepsy
Work Value
80188........................ 0.00
© 2014 OptumInsight, Inc.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.00
0.00
0.00
0.00
0.00
CPT © 2014 American Medical Association. All Rights Reserved.
105
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
80196
80196
Salicylate
Explanation
This drug is known universally as aspirin and may also be referred to
as a nonsteroidal antiinflammatory drug (NSAID). Specimen collection
is at trough, which is the time just before the next dose of the drug
when blood concentration is at its lowest. Overdose may also prompt
this test. Methodology may include high performance liquid
chromatography (HPLC) or gas liquid chromatography (GLC).
Colorimetry and fluorometry may also be used.
Coding Tips
This examination is quantitative. See codes from range 80100–80103
for nonquantitative testing. If a specimen is transported to an outside
laboratory, report code 99000 for handling or conveyance. When the
medical record documentation indicates that the patient suffered an
overdose of the drug, either accidental or as a suicide attempt, see the
Table of Drugs and Chemicals to locate the appropriate external cause
(E) code.
Terms To Know
assay. Test of purity.
NSAID. Non-steroidal antiinflammatory drug. Analgesic and antiinflammatory
drug commonly used to mitigate inflammatory conditions. NSAIDs include
aspirin, ibuprofen, naproxen, and nabumetone.
quantitative. To determine the amount and nature of the components of a
substance.
specimen. Tissue cells or sample of fluid taken for analysis, pathologic
examination, and diagnosis.
venipuncture. Piercing a vein through the skin by a needle and syringe or
sharp-ended cannula or catheter to draw blood, start an intravenous infusion,
instill medication, or inject another substance such as radiopaque dye.
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
CCI Version 20.0
No CCI Edits apply to this code.
Work Value
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
80196........................ 0.00
0.00
0.00
0.00
0.00
0.00
106
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
82055
82055
303.02
Alcohol (ethanol); any specimen except breath
Explanation
303.03
This test may also be requested as ethanol, ethyl alcohol, or ETOH. If
the specimen is blood (serum), collection is typically by venipuncture.
Method is commonly enzymatic rate analysis (alcohol dehydrogenase).
This test is typically performed to determine alcohol level for medical
or legal purposes, to screen unconscious patients, to diagnose alcohol
intoxication to determine appropriate therapy, and to monitor ethanol
treatment for methanol intoxication.
303.90
303.91
Coding Tips
Code 82055 is classified as a CLIA-waived test. Append with modifier
QW. If a specimen is transported to an outside laboratory, report 99000
for handling or conveyance. For an alcohol breath test, see 82075. For
alcohol volatiles, such as isopropyl alcohol, see 84600. Codes in
categories 303 Alcohol dependence syndrome, and 305 Nondependent
use of drugs, are reported using fifth-digit subclassifications that more
specifically describe the episode of abuse. These are: 0 Unspecified, 1
Continuous, 2 Episodic, and 3 In remission.
303.92
303.93
Terms To Know
ETOH. Alcohol.
specimen. Tissue cells or sample of fluid taken for analysis, pathologic
examination, and diagnosis.
venipuncture. Piercing a vein through the skin by a needle and syringe or
sharp-ended cannula or catheter to draw blood, start an intravenous infusion,
instill medication, or inject another substance such as radiopaque dye.
ICD-9-CM Diagnostic Codes
070.20
070.21
070.30
070.31
070.41
070.51
291.0
303.00
303.01
Viral hepatitis B with hepatic coma, acute or unspecified,
without mention of hepatitis delta
Viral hepatitis B with hepatic coma, acute or unspecified,
with hepatitis delta
Viral hepatitis B without mention of hepatic coma, acute
or unspecified, without mention of hepatitis delta
Viral hepatitis B without mention of hepatic coma, acute
or unspecified, with hepatitis delta
Acute hepatitis C with hepatic coma
Acute hepatitis C without mention of hepatic coma
Alcohol withdrawal delirium
Acute alcoholic intoxication, unspecified — (Use additional
code to identify any associated condition: 291.0-291.9,
304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2,
571.3)
Acute alcoholic intoxication, continuous — (Use additional
code to identify any associated condition: 291.0-291.9,
304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2,
571.3)
Work Value
82055........................ 0.00
© 2014 OptumInsight, Inc.
305.00
305.01
305.02
305.03
571.2
980.0
Acute alcoholic intoxication, episodic — (Use additional
code to identify any associated condition: 291.0-291.9,
304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2,
571.3)
Acute alcoholic intoxication, in remission — (Use additional
code to identify any associated condition: 291.0-291.9,
304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2,
571.3)
Other and unspecified alcohol dependence, unspecified
— (Use additional code to identify any associated condition:
291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3,
571.1, 571.2, 571.3)
Other and unspecified alcohol dependence, continuous —
(Use additional code to identify any associated condition:
291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3,
571.1, 571.2, 571.3)
Other and unspecified alcohol dependence, episodic —
(Use additional code to identify any associated condition:
291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3,
571.1, 571.2, 571.3)
Other and unspecified alcohol dependence, in remission
— (Use additional code to identify any associated condition:
291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3,
571.1, 571.2, 571.3)
Nondependent alcohol abuse, unspecified
Nondependent alcohol abuse, continuous
Nondependent alcohol abuse, episodic
Nondependent alcohol abuse, in remission
Alcoholic cirrhosis of liver
Toxic effect of ethyl alcohol — (Use additional code to
specify the nature of the toxic effect. Use additional code
to identify any associated: 291.4, 303.0, 305.0)
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
IOM References
100-4,16,70.8
CCI Version 20.0
No CCI Edits apply to this code.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.00
0.00
0.00
0.00
0.00
CPT © 2014 American Medical Association. All Rights Reserved.
107
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
82075
82075
303.92
Alcohol (ethanol); breath
303.93
Explanation
This test may be used primarily in screening for ethanol levels above
the legal limit for driving. The legal limit varies from state to state with
levels above 0.08-0.1 g/dL usually being defined as legally intoxicated.
Coding Tips
If a specimen is transported to an outside laboratory, report code 99000
for handling or conveyance. For an alcohol test, any specimen except
breath, see code 82055. For alcohol volatiles, such as isopropyl alcohol,
see 84600. Codes in categories 303 Alcohol dependence syndrome,
and 305 Nondependent use of drugs, are reported using fifth-digit
subclassifications that more specifically describe the episode of abuse.
These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission.
Terms To Know
screening test. Exam or study used by a physician to identify abnormalities,
regardless of whether the patient exhibits symptoms.
303.01
303.02
303.03
303.90
303.91
Alcohol-induced persisting dementia
Alcohol-induced psychotic disorder with hallucinations
Idiosyncratic alcohol intoxication
Alcohol-induced psychotic disorder with delusions
Acute alcoholic intoxication, unspecified — (Use additional
code to identify any associated condition: 291.0-291.9,
304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2,
571.3)
Acute alcoholic intoxication, continuous — (Use additional
code to identify any associated condition: 291.0-291.9,
304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2,
571.3)
Acute alcoholic intoxication, episodic — (Use additional
code to identify any associated condition: 291.0-291.9,
304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2,
571.3)
Acute alcoholic intoxication, in remission — (Use additional
code to identify any associated condition: 291.0-291.9,
304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2,
571.3)
Other and unspecified alcohol dependence, unspecified
— (Use additional code to identify any associated condition:
291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3,
571.1, 571.2, 571.3)
Other and unspecified alcohol dependence, continuous —
(Use additional code to identify any associated condition:
291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3,
571.1, 571.2, 571.3)
Work Value
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
ICD-9-CM Diagnostic Codes
291.2
291.3
291.4
291.5
303.00
305.00
305.01
305.02
305.03
980.0
Other and unspecified alcohol dependence, episodic —
(Use additional code to identify any associated condition:
291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3,
571.1, 571.2, 571.3)
Other and unspecified alcohol dependence, in remission
— (Use additional code to identify any associated condition:
291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3,
571.1, 571.2, 571.3)
Nondependent alcohol abuse, unspecified
Nondependent alcohol abuse, continuous
Nondependent alcohol abuse, episodic
Nondependent alcohol abuse, in remission
Toxic effect of ethyl alcohol — (Use additional code to
specify the nature of the toxic effect. Use additional code
to identify any associated: 291.4, 303.0, 305.0)
No CCI Edits apply to this code.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
82075........................ 0.00
0.00
0.00
0.00
0.00
0.00
108
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
82145
82145
305.90
305.91
Amphetamine or methamphetamine
305.92
Explanation
This test may be requested as a quantitative analysis of
amphetamine/methamphetamine. A number of methods are used.
Methods used for blood include gas-liquid chromatography (GLC), gas
chromatometry/mass spectrometry (GC/MS), and radioimmunoassay
(RIA). Methods used for urine include enzyme immunoassay (EIA), high
performance liquid chromatography (HPLC), fluorescence polarization
immunoassay (FPIA), and RIA. This test measures (quantifies) the amount
of amphetamine or methamphetamine in the urine.
Coding Tips
Qualitative analysis should be identified using the appropriate code
from range 80100–80103. Codes in categories 304 Drug dependence,
and 305 Nondependent use of drugs, are reported using fifth-digit
subclassifications that more specifically describe the episode of abuse.
These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission.
When the medical record documentation indicates that the patient
suffered an overdose of the drug, either accidental or as a suicide
attempt, see the Table of Drugs and Chemicals to locate the appropriate
external cause (E) code.
305.93
780.1
780.97
Other, mixed, or unspecified nondependent drug abuse,
unspecified
Other, mixed, or unspecified nondependent drug abuse,
continuous
Other, mixed, or unspecified nondependent drug abuse,
episodic
Other, mixed, or unspecified nondependent drug abuse,
in remission
Hallucinations
Altered mental status
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
Terms To Know
assay. Test of purity.
quantitative. To determine the amount and nature of the components of a
substance.
specimen. Tissue cells or sample of fluid taken for analysis, pathologic
examination, and diagnosis.
venipuncture. Piercing a vein through the skin by a needle and syringe or
sharp-ended cannula or catheter to draw blood, start an intravenous infusion,
instill medication, or inject another substance such as radiopaque dye.
ICD-9-CM Diagnostic Codes
297.9
298.9
304.90
305.70
305.71
305.72
305.73
Unspecified paranoid state — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Unspecified psychosis — (Use additional code to identify
any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Unspecified drug dependence, unspecified
Nondependent amphetamine or related acting
sympathomimetic abuse, unspecified
Nondependent amphetamine or related acting
sympathomimetic abuse, continuous
Nondependent amphetamine or related acting
sympathomimetic abuse, episodic
Nondependent amphetamine or related acting
sympathomimetic abuse, in remission
Work Value
82145........................ 0.00
© 2014 OptumInsight, Inc.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.00
0.00
0.00
0.00
0.00
CPT © 2014 American Medical Association. All Rights Reserved.
109
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
82205
82205
305.93
780.97
967.0
Barbiturates, not elsewhere specified
Explanation
This test may be requested as a quantitative analysis of barbiturates. A
number of methods are used. Methods used for blood include gas-liquid
chromatography (GLC), gas chromatometry/mass spectrometry
(GC/MS), and radioimmunoassay (RIA). Methods used for urine include
enzyme immunoassay (EIA) and high performance liquid
chromatography (HPLC). This test measures (quantifies) the amount
of barbiturate.
Coding Tips
Qualitative analysis should be identified using the appropriate code
from range 80100–80103. Codes in categories 304 Drug dependence,
and 305 Nondependent use of drugs, are reported using fifth-digit
subclassifications that more specifically describe the episode of abuse.
These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission.
When the medical record documentation indicates that the patient
suffered an overdose of the drug, either accidental or as a suicide
attempt, see the Table of Drugs and Chemicals to locate the appropriate
external cause (E) code.
V70.4
V72.62
Other, mixed, or unspecified nondependent drug abuse,
in remission
Altered mental status
Poisoning by barbiturates — (Use additional code to specify
the effects of poisoning)
Examination for medicolegal reason — (Use additional
code(s) to identify any special screening examination(s)
performed: V73.0-V82.9)
Laboratory examination ordered as part of a routine general
medical examination
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
Terms To Know
analysis. Study of body fluid, tissue, section, or parts.
assay. Test of purity.
quantitative. To determine the amount and nature of the components of a
substance.
specimen. Tissue cells or sample of fluid taken for analysis, pathologic
examination, and diagnosis.
ICD-9-CM Diagnostic Codes
304.10
304.11
304.12
304.13
304.90
305.40
305.41
305.42
305.43
305.90
305.91
305.92
Sedative, hypnotic or anxiolytic dependence, unspecified
Sedative, hypnotic or anxiolytic dependence, continuous
Sedative, hypnotic or anxiolytic dependence, episodic
Sedative, hypnotic or anxiolytic dependence, in remission
Unspecified drug dependence, unspecified
Nondependent sedative, hypnotic or anxiolytic abuse,
unspecified
Nondependent sedative hypnotic or anxiolytic abuse,
continuous
Nondependent sedative, hypnotic or anxiolytic abuse,
episodic
Nondependent sedative, hypnotic or anxiolytic abuse, in
remission
Other, mixed, or unspecified nondependent drug abuse,
unspecified
Other, mixed, or unspecified nondependent drug abuse,
continuous
Other, mixed, or unspecified nondependent drug abuse,
episodic
Work Value
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
82205........................ 0.00
0.00
0.00
0.00
0.00
0.00
110
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
82520
82520
305.63
305.90
Cocaine or metabolite
305.91
Explanation
Cocaine is a refined derivative of the coca plant and is a frequently
abused drug. Blood specimen is obtained by venipuncture. Multiple
methods may be used including enzyme immunoassay (EIA),
fluorescence polarization immunoassay (FPIA), radioimmunoassay (RIA),
gas-liquid chromatography (GLC), high performance liquid
chromatography (HPLC), and gas chromatography/mass spectrometry
(GC-MS). The procedure measures (quantifies) the amount of cocaine
or its metabolites in the sample.
Coding Tips
Qualitative analysis should be identified using the appropriate code
from range 80100-80103. Codes in categories 304 Drug dependence,
and 305 Nondependent use of drugs are reported using fifth-digit
subclassifications that more specifically describe the episode of abuse.
These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission.
When the medical record documentation indicates that the patient
suffered an overdose of the drug, either accidental or as a suicide
attempt, see the Table of Drugs and Chemicals to locate the appropriate
external cause (E) code.
Terms To Know
assay. Test of purity.
specimen. Tissue cells or sample of fluid taken for analysis, pathologic
examination, and diagnosis.
venipuncture. Piercing a vein through the skin by a needle and syringe or
sharp-ended cannula or catheter to draw blood, start an intravenous infusion,
instill medication, or inject another substance such as radiopaque dye.
305.92
305.93
780.1
780.97
970.81
V70.4
V72.62
Nondependent cocaine abuse, in remission
Other, mixed, or unspecified nondependent drug abuse,
unspecified
Other, mixed, or unspecified nondependent drug abuse,
continuous
Other, mixed, or unspecified nondependent drug abuse,
episodic
Other, mixed, or unspecified nondependent drug abuse,
in remission
Hallucinations
Altered mental status
Poisoning by cocaine
Examination for medicolegal reason — (Use additional
code(s) to identify any special screening examination(s)
performed: V73.0-V82.9)
Laboratory examination ordered as part of a routine general
medical examination
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
ICD-9-CM Diagnostic Codes
292.89
297.9
298.9
300.09
304.20
304.21
304.22
304.23
304.90
305.60
305.61
305.62
Other specified drug-induced mental disorder — (Use
additional code for any associated drug dependence:
304.0-304.9. Use additional E code to identify drug)
Unspecified paranoid state — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Unspecified psychosis — (Use additional code to identify
any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Other anxiety states
Cocaine dependence, unspecified
Cocaine dependence, continuous
Cocaine dependence, episodic
Cocaine dependence, in remission
Unspecified drug dependence, unspecified
Nondependent cocaine abuse, unspecified
Nondependent cocaine abuse, continuous
Nondependent cocaine abuse, episodic
Work Value
82520........................ 0.00
© 2014 OptumInsight, Inc.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.00
0.00
0.00
0.00
0.00
CPT © 2014 American Medical Association. All Rights Reserved.
111
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
82646
82646
305.50
305.51
305.52
305.53
305.90
Dihydrocodeinone
Explanation
This test may be requested as hydrocodone quantitative analysis.
Dihydrocodeinone is an opioid having sedative and analgesic effects.
Methods include radioimmunoassay (RIA), gas-liquid chromatography
(GLC), enzyme immunoassay (EIA), high-performance liquid
chromatography (HPLC) for blood, and fluorescence polarization
immunoassay (FPIA) for urine. This test measures (quantifies) the
amount of dihydrocodeinone present.
Coding Tips
305.91
305.92
305.93
338.0
Qualitative analysis should be identified using the appropriate code
from range 80100–80103. Codes in categories 304 Drug dependence,
and 305 Nondependent use of drugs, are reported using fifth-digit
subclassifications that more specifically describe the episode of abuse.
These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission.
This drug may also be used in the treatment of pain. ICD-9-CM category
338 Pain, not elsewhere classified, provides subclassification codes that
enable reporting of specific underlying causes of pain, as well as its
acuity or chronicity. Category 338 contains an instructional note to
coders to use an additional code (307.89) to identify pain associated
with psychological factors. It also contains an exclusions note for
generalized and localized pain, as well as pain disorder exclusively
attributed to psychological factors. When the medical record
documentation indicates that the patient suffered an overdose of the
drug, either accidental or as a suicide attempt, see the Table of Drugs
and Chemicals to locate the appropriate external cause (E) code.
Terms To Know
338.19
338.29
338.4
965.09
Nondependent opioid abuse, unspecified
Nondependent opioid abuse, continuous
Nondependent opioid abuse, episodic
Nondependent opioid abuse, in remission
Other, mixed, or unspecified nondependent drug abuse,
unspecified
Other, mixed, or unspecified nondependent drug abuse,
continuous
Other, mixed, or unspecified nondependent drug abuse,
episodic
Other, mixed, or unspecified nondependent drug abuse,
in remission
Central pain syndrome — (Use additional code to identify
pain associated with psychological factors: 307.89)
Other acute pain — (Use additional code to identify pain
associated with psychological factors: 307.89)
Other chronic pain — (Use additional code to identify pain
associated with psychological factors: 307.89)
Chronic pain syndrome — (Use additional code to identify
pain associated with psychological factors: 307.89)
Poisoning by opiates and related narcotics, other — (Use
additional code to specify the effects of poisoning)
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
analgesia. Absence of a normal sense of pain without loss of consciousness.
assay. Test of purity.
quantitative. To determine the amount and nature of the components of a
substance.
ICD-9-CM Diagnostic Codes
292.89
297.9
298.9
304.00
304.01
304.02
304.03
304.90
Other specified drug-induced mental disorder — (Use
additional code for any associated drug dependence:
304.0-304.9. Use additional E code to identify drug)
Unspecified paranoid state — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Unspecified psychosis — (Use additional code to identify
any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Opioid type dependence, unspecified
Opioid type dependence, continuous
Opioid type dependence, episodic
Opioid type dependence, in remission
Unspecified drug dependence, unspecified
Work Value
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
82646........................ 0.00
0.00
0.00
0.00
0.00
0.00
112
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
82649
82649
305.90
305.91
Dihydromorphinone
305.92
Explanation
This test may be requested as hydromorphone or Dilaudid quantitative
analysis. Dihydromorphinone is an opioid. Methods include
radioimmunoassay (RIA), gas-liquid chromatography (GLC), and enzyme
immunoassay (EIA).
Coding Tips
305.93
338.0
338.19
Qualitative analysis should be identified using the appropriate code
from range 80100-80103. Codes in categories 304 Drug dependence,
and 305 Nondependent use of drugs, are reported using fifth-digit
subclassifications that more specifically describe the episode of abuse.
These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission.
This drug may also be used in the treatment of pain. ICD-9-CM category
338 Pain, not elsewhere classified, provides subclassification codes that
enable reporting of specific underlying causes of pain, as well as its
acuity or chronicity. Category 338 contains an instructional note to
coders to use an additional code (307.89) to identify pain associated
with psychological factors. It also contains an exclusions note for
generalized and localized pain, as well as pain disorder exclusively
attributed to psychological factors. When the medical record
documentation indicates that the patient suffered an overdose of the
drug, either accidental or as a suicide attempt, see the Table of Drugs
and Chemicals to locate the appropriate external cause (E) code.
338.29
338.4
965.09
Other, mixed, or unspecified nondependent drug abuse,
unspecified
Other, mixed, or unspecified nondependent drug abuse,
continuous
Other, mixed, or unspecified nondependent drug abuse,
episodic
Other, mixed, or unspecified nondependent drug abuse,
in remission
Central pain syndrome — (Use additional code to identify
pain associated with psychological factors: 307.89)
Other acute pain — (Use additional code to identify pain
associated with psychological factors: 307.89)
Other chronic pain — (Use additional code to identify pain
associated with psychological factors: 307.89)
Chronic pain syndrome — (Use additional code to identify
pain associated with psychological factors: 307.89)
Poisoning by opiates and related narcotics, other — (Use
additional code to specify the effects of poisoning)
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
Terms To Know
qualitative. To determine the nature of the component of substance.
quantitative. To determine the amount and nature of the components of a
substance.
ICD-9-CM Diagnostic Codes
292.89
297.9
298.9
304.00
304.01
304.02
304.03
304.90
305.50
305.51
305.52
305.53
Other specified drug-induced mental disorder — (Use
additional code for any associated drug dependence:
304.0-304.9. Use additional E code to identify drug)
Unspecified paranoid state — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Unspecified psychosis — (Use additional code to identify
any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Opioid type dependence, unspecified
Opioid type dependence, continuous
Opioid type dependence, episodic
Opioid type dependence, in remission
Unspecified drug dependence, unspecified
Nondependent opioid abuse, unspecified
Nondependent opioid abuse, continuous
Nondependent opioid abuse, episodic
Nondependent opioid abuse, in remission
Work Value
82649........................ 0.00
© 2014 OptumInsight, Inc.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.00
0.00
0.00
0.00
0.00
CPT © 2014 American Medical Association. All Rights Reserved.
113
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
82654
82654
305.50
305.51
305.52
305.53
305.90
Dimethadione
Explanation
This test may be requested as Methadone or Dolophine quantitative
analysis. Dimethadione is an opioid. Methods include radioimmunoassay
(RIA), gas-liquid chromatography (GLC), enzyme immunoassay (EIA),
and high-performance liquid chromatography (HPLC).
Coding Tips
Qualitative analysis should be identified using the appropriate code
from range 80100-80103. Codes in categories 304 Drug dependence
and 305 Nondependent use of drugs are reported using fifth-digit
subclassifications that more specifically describe the episode of abuse.
These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission.
This drug may also be used in the treatment of pain. ICD-9-CM category
338 Pain, not elsewhere classified, provides subclassification codes that
enable reporting of specific underlying causes of pain, as well as its
acuity or chronicity. Category 338 contains an instructional note to
coders to use an additional code (307.89) to identify pain associated
with psychological factors. It also contains an exclusions note for
generalized and localized pain, as well as pain disorder exclusively
attributed to psychological factors. When the medical record
documentation indicates that the patient suffered an overdose of the
drug, either accidental or as a suicide attempt, see the Table of Drugs
and Chemicals to locate the appropriate external cause (E) code.
Terms To Know
305.91
305.92
305.93
338.0
338.19
965.02
V58.69
Nondependent opioid abuse, unspecified
Nondependent opioid abuse, continuous
Nondependent opioid abuse, episodic
Nondependent opioid abuse, in remission
Other, mixed, or unspecified nondependent drug abuse,
unspecified
Other, mixed, or unspecified nondependent drug abuse,
continuous
Other, mixed, or unspecified nondependent drug abuse,
episodic
Other, mixed, or unspecified nondependent drug abuse,
in remission
Central pain syndrome — (Use additional code to identify
pain associated with psychological factors: 307.89)
Other acute pain — (Use additional code to identify pain
associated with psychological factors: 307.89)
Poisoning by methadone — (Use additional code to specify
the effects of poisoning)
Long-term (current) use of other medications
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
quantitative. To determine the amount and nature of the components of a
substance.
specimen. Tissue cells or sample of fluid taken for analysis, pathologic
examination, and diagnosis.
venipuncture. Piercing a vein through the skin by a needle and syringe or
sharp-ended cannula or catheter to draw blood, start an intravenous infusion,
instill medication, or inject another substance such as radiopaque dye.
ICD-9-CM Diagnostic Codes
292.89
297.9
298.9
304.00
304.01
304.02
304.03
304.90
Other specified drug-induced mental disorder — (Use
additional code for any associated drug dependence:
304.0-304.9. Use additional E code to identify drug)
Unspecified paranoid state — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Unspecified psychosis — (Use additional code to identify
any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Opioid type dependence, unspecified
Opioid type dependence, continuous
Opioid type dependence, episodic
Opioid type dependence, in remission
Unspecified drug dependence, unspecified
Work Value
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
82654........................ 0.00
0.00
0.00
0.00
0.00
0.00
114
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
82690
82690
305.93
Ethchlorvynol
Explanation
This test may be requested as Placidyl quantitative analysis.
Ethchlorvynol is a non-barbiturate sedative and hypnotic. Method is
gas-liquid chromatography (GLC) or colorimetry. This test measures
(quantitates) the amount of the drug present.
Coding Tips
Qualitative analysis should be identified using the appropriate code
from range 80100–80103. Codes in categories 304 Drug dependence,
and 305 Nondependent use of drugs, are reported using fifth-digit
subclassifications that more specifically describe the episode of abuse.
These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission.
When the medical record documentation indicates that the patient
suffered an overdose of the drug, either accidental or as a suicide
attempt, see the Table of Drugs and Chemicals to locate the appropriate
external cause (E) code.
307.41
307.42
780.52
967.8
V58.69
Other, mixed, or unspecified nondependent drug abuse,
in remission
Transient disorder of initiating or maintaining sleep
Persistent disorder of initiating or maintaining sleep
Insomnia, unspecified
Poisoning by other sedatives and hypnotics — (Use
additional code to specify the effects of poisoning)
Long-term (current) use of other medications
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
Terms To Know
qualitative. To determine the nature of the component of substance.
quantitative. To determine the amount and nature of the components of a
substance.
specimen. Tissue cells or sample of fluid taken for analysis, pathologic
examination, and diagnosis.
venipuncture. Piercing a vein through the skin by a needle and syringe or
sharp-ended cannula or catheter to draw blood, start an intravenous infusion,
instill medication, or inject another substance such as radiopaque dye.
ICD-9-CM Diagnostic Codes
304.10
304.11
304.12
304.13
304.90
305.40
305.41
305.42
305.43
305.90
305.91
305.92
Sedative, hypnotic or anxiolytic dependence, unspecified
Sedative, hypnotic or anxiolytic dependence, continuous
Sedative, hypnotic or anxiolytic dependence, episodic
Sedative, hypnotic or anxiolytic dependence, in remission
Unspecified drug dependence, unspecified
Nondependent sedative, hypnotic or anxiolytic abuse,
unspecified
Nondependent sedative hypnotic or anxiolytic abuse,
continuous
Nondependent sedative, hypnotic or anxiolytic abuse,
episodic
Nondependent sedative, hypnotic or anxiolytic abuse, in
remission
Other, mixed, or unspecified nondependent drug abuse,
unspecified
Other, mixed, or unspecified nondependent drug abuse,
continuous
Other, mixed, or unspecified nondependent drug abuse,
episodic
Work Value
82690........................ 0.00
© 2014 OptumInsight, Inc.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.00
0.00
0.00
0.00
0.00
CPT © 2014 American Medical Association. All Rights Reserved.
115
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
82742
82742
305.92
305.93
Flurazepam
Explanation
This test may be requested as Dalmane, quantitative analysis.
Flurazepam is a benzodiazepine with sedative and hypnotic effects.
Method is gas chromatography (GC), gas chromatography-mass
spectrometry (GC-MS), high performance liquid chromatography
(HPLC), or thin layer chromatography (TLC). This test measures
(quantitates) the amount of the drug present.
307.41
307.42
780.52
967.8
V58.69
V70.4
Coding Tips
Qualitative analysis should be identified using the appropriate code
from range 80100-80103. Codes in categories 304 Drug dependence,
and 305 Nondependent use of drugs are reported using fifth-digit
subclassifications that more specifically describe the episode of abuse.
These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission.
When the medical record documentation indicates that the patient
suffered an overdose of the drug, either accidental or as a suicide
attempt, see the Table of Drugs and Chemicals to locate the appropriate
external cause (E) code.
V72.60
Other, mixed, or unspecified nondependent drug abuse,
episodic
Other, mixed, or unspecified nondependent drug abuse,
in remission
Transient disorder of initiating or maintaining sleep
Persistent disorder of initiating or maintaining sleep
Insomnia, unspecified
Poisoning by other sedatives and hypnotics — (Use
additional code to specify the effects of poisoning)
Long-term (current) use of other medications
Examination for medicolegal reason — (Use additional
code(s) to identify any special screening examination(s)
performed: V73.0-V82.9)
Laboratory examination, unspecified
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
Terms To Know
specimen. Tissue cells or sample of fluid taken for analysis, pathologic
examination, and diagnosis.
venipuncture. Piercing a vein through the skin by a needle and syringe or
sharp-ended cannula or catheter to draw blood, start an intravenous infusion,
instill medication, or inject another substance such as radiopaque dye.
ICD-9-CM Diagnostic Codes
304.10
304.11
304.12
304.13
304.90
304.91
304.92
304.93
305.40
305.41
305.42
305.43
305.90
305.91
Sedative, hypnotic or anxiolytic dependence, unspecified
Sedative, hypnotic or anxiolytic dependence, continuous
Sedative, hypnotic or anxiolytic dependence, episodic
Sedative, hypnotic or anxiolytic dependence, in remission
Unspecified drug dependence, unspecified
Unspecified drug dependence, continuous
Unspecified drug dependence, episodic
Unspecified drug dependence, in remission
Nondependent sedative, hypnotic or anxiolytic abuse,
unspecified
Nondependent sedative hypnotic or anxiolytic abuse,
continuous
Nondependent sedative, hypnotic or anxiolytic abuse,
episodic
Nondependent sedative, hypnotic or anxiolytic abuse, in
remission
Other, mixed, or unspecified nondependent drug abuse,
unspecified
Other, mixed, or unspecified nondependent drug abuse,
continuous
Work Value
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
82742........................ 0.00
0.00
0.00
0.00
0.00
0.00
116
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
82980
82980
305.93
Glutethimide
Explanation
This test may be requested as Doriden level. Glutethimide is a
nonbarbiturate similar to phenobarbital and used as a sedative and
hypnotic. Method is gas-liquid chromatography (GLC), high
performance liquid chromatography (HPLC), or gas
chromatography-mass spectrometry (GC-MS). The test measures
(quantifies) the amount of the drug.
Coding Tips
Qualitative analysis should be identified using the appropriate code
from range 80100-80103. Codes in categories 304 Drug dependence,
and 305 Nondependent use of drugs, are reported using fifth-digit
subclassifications that more specifically describe the episode of abuse.
These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission.
When the medical record documentation indicates that the patient
suffered an overdose of the drug, either accidental or as a suicide
attempt, see the Table of Drugs and Chemicals to locate the appropriate
external cause (E) code.
307.40
307.41
307.42
307.47
307.48
780.97
967.5
967.8
V58.69
Other, mixed, or unspecified nondependent drug abuse,
in remission
Nonorganic sleep disorder, unspecified
Transient disorder of initiating or maintaining sleep
Persistent disorder of initiating or maintaining sleep
Other dysfunctions of sleep stages or arousal from sleep
Repetitive intrusions of sleep
Altered mental status
Poisoning by glutethimide group — (Use additional code
to specify the effects of poisoning)
Poisoning by other sedatives and hypnotics — (Use
additional code to specify the effects of poisoning)
Long-term (current) use of other medications
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
Terms To Know
specimen. Tissue cells or sample of fluid taken for analysis, pathologic
examination, and diagnosis.
venipuncture. Piercing a vein through the skin by a needle and syringe or
sharp-ended cannula or catheter to draw blood, start an intravenous infusion,
instill medication, or inject another substance such as radiopaque dye.
ICD-9-CM Diagnostic Codes
304.10
304.11
304.12
304.13
304.90
305.40
305.41
305.42
305.43
305.90
305.91
305.92
Sedative, hypnotic or anxiolytic dependence, unspecified
Sedative, hypnotic or anxiolytic dependence, continuous
Sedative, hypnotic or anxiolytic dependence, episodic
Sedative, hypnotic or anxiolytic dependence, in remission
Unspecified drug dependence, unspecified
Nondependent sedative, hypnotic or anxiolytic abuse,
unspecified
Nondependent sedative hypnotic or anxiolytic abuse,
continuous
Nondependent sedative, hypnotic or anxiolytic abuse,
episodic
Nondependent sedative, hypnotic or anxiolytic abuse, in
remission
Other, mixed, or unspecified nondependent drug abuse,
unspecified
Other, mixed, or unspecified nondependent drug abuse,
continuous
Other, mixed, or unspecified nondependent drug abuse,
episodic
Work Value
82980........................ 0.00
© 2014 OptumInsight, Inc.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.00
0.00
0.00
0.00
0.00
CPT © 2014 American Medical Association. All Rights Reserved.
117
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
83805
83805
305.42
305.43
Meprobamate
305.90
Explanation
This test is performed to provide therapeutic monitoring and toxicity
evaluation of this antianxiety agent (numerous trade names exist,
including Equanil and Meprospan). Method used is gas-liquid
chromatography or high performance liquid chromatography.
Quantitative measurement may be taken for numerous reasons.
305.91
305.92
305.93
Coding Tips
Qualitative analysis should be identified using the appropriate code
from range 80100–80103. To report the professional services for drug
management, see HCPCS Level II code M0064, CPT code 90863, the
appropriate level of E/M service, or the appropriate psychotherapy with
E/M service code. Follow third-party payer guidelines when selecting
the appropriate code for these services. Codes in categories 304 Drug
dependence, and 305 Nondependent use of drugs, are reported using
fifth-digit subclassifications that more specifically describe the episode
of abuse. These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In
remission. When the medical record documentation indicates that the
patient suffered an overdose of the drug, either accidental or as a suicide
attempt, see the Table of Drugs and Chemicals to locate the appropriate
external cause (E) code.
Terms To Know
quantitative. To determine the amount and nature of the components of a
substance.
therapeutic. Act meant to alleviate a medical or mental condition.
venipuncture. Piercing a vein through the skin by a needle and syringe or
sharp-ended cannula or catheter to draw blood, start an intravenous infusion,
instill medication, or inject another substance such as radiopaque dye.
780.97
969.5
V58.69
V70.4
V72.60
Nondependent sedative, hypnotic or anxiolytic abuse,
episodic
Nondependent sedative, hypnotic or anxiolytic abuse, in
remission
Other, mixed, or unspecified nondependent drug abuse,
unspecified
Other, mixed, or unspecified nondependent drug abuse,
continuous
Other, mixed, or unspecified nondependent drug abuse,
episodic
Other, mixed, or unspecified nondependent drug abuse,
in remission
Altered mental status
Poisoning by other tranquilizers — (Use additional code
to specify the effects of poisoning)
Long-term (current) use of other medications
Examination for medicolegal reason — (Use additional
code(s) to identify any special screening examination(s)
performed: V73.0-V82.9)
Laboratory examination, unspecified
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
ICD-9-CM Diagnostic Codes
300.00
300.01
300.02
300.09
304.10
304.11
304.12
304.13
304.90
304.91
304.92
304.93
305.40
305.41
Anxiety state, unspecified
Panic disorder without agoraphobia
Generalized anxiety disorder
Other anxiety states
Sedative, hypnotic or anxiolytic dependence, unspecified
Sedative, hypnotic or anxiolytic dependence, continuous
Sedative, hypnotic or anxiolytic dependence, episodic
Sedative, hypnotic or anxiolytic dependence, in remission
Unspecified drug dependence, unspecified
Unspecified drug dependence, continuous
Unspecified drug dependence, episodic
Unspecified drug dependence, in remission
Nondependent sedative, hypnotic or anxiolytic abuse,
unspecified
Nondependent sedative hypnotic or anxiolytic abuse,
continuous
Work Value
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
83805........................ 0.00
0.00
0.00
0.00
0.00
0.00
118
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
83840
83840
305.50
305.51
305.52
305.53
305.90
Methadone
Explanation
This test is used to measure toxicity and the determination of
methadone in the system in cases of drug abuse. The specimen is a
random urine sample. Methods for screening purposes are thin-layer
chromatography and enzyme immunoassay; for confirmation, gas
chromatography/mass spectrometry. This agent is widely used in the
detoxification of opiate addicts.
Coding Tips
Qualitative analysis should be identified using the appropriate code
from range 80100-80103. Codes in categories 304 Drug dependence,
and 305 Nondependent use of drugs, are reported using fifth-digit
subclassifications that more specifically describe the episode of abuse.
These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission.
This drug may also be used in the treatment of pain. ICD-9-CM category
338 Pain, not elsewhere classified, provides subclassification codes that
enable reporting of specific underlying causes of pain, as well as its
acuity or chronicity. Category 338 contains an instructional note to
coders to use an additional code (307.89) to identify pain associated
with psychological factors. It also contains an exclusions note for
generalized and localized pain, as well as pain disorder exclusively
attributed to psychological factors. When the medical record
documentation indicates that the patient suffered an overdose of the
drug, either accidental or as a suicide attempt, see the Table of Drugs
and Chemicals to locate the appropriate external cause (E) code.
Terms To Know
qualitative. To determine the nature of the component of substance.
quantitative. To determine the amount and nature of the components of a
substance.
specimen. Tissue cells or sample of fluid taken for analysis, pathologic
examination, and diagnosis.
305.91
305.92
305.93
338.4
965.02
965.09
V58.69
V70.4
V72.60
Nondependent opioid abuse, unspecified
Nondependent opioid abuse, continuous
Nondependent opioid abuse, episodic
Nondependent opioid abuse, in remission
Other, mixed, or unspecified nondependent drug abuse,
unspecified
Other, mixed, or unspecified nondependent drug abuse,
continuous
Other, mixed, or unspecified nondependent drug abuse,
episodic
Other, mixed, or unspecified nondependent drug abuse,
in remission
Chronic pain syndrome — (Use additional code to identify
pain associated with psychological factors: 307.89)
Poisoning by methadone — (Use additional code to specify
the effects of poisoning)
Poisoning by opiates and related narcotics, other — (Use
additional code to specify the effects of poisoning)
Long-term (current) use of other medications
Examination for medicolegal reason — (Use additional
code(s) to identify any special screening examination(s)
performed: V73.0-V82.9)
Laboratory examination, unspecified
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
ICD-9-CM Diagnostic Codes
292.89
297.9
298.9
304.00
304.01
304.02
304.03
304.90
Other specified drug-induced mental disorder — (Use
additional code for any associated drug dependence:
304.0-304.9. Use additional E code to identify drug)
Unspecified paranoid state — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Unspecified psychosis — (Use additional code to identify
any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Opioid type dependence, unspecified
Opioid type dependence, continuous
Opioid type dependence, episodic
Opioid type dependence, in remission
Unspecified drug dependence, unspecified
Work Value
83840........................ 0.00
© 2014 OptumInsight, Inc.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.00
0.00
0.00
0.00
0.00
CPT © 2014 American Medical Association. All Rights Reserved.
119
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
83925
83925
Opiate(s), drug and metabolites, each procedure
Explanation
Test methods include thin-layer chromatography, enzyme immunoassay,
gas chromatography, and high performance liquid chromatography.
This test measures the amount of a given opiate present and may be
ordered to measure toxicity or possible drug abuse of opiates, such as
morphine and meperidine (Demerol). Report 83925 for each test
procedure for drugs and metabolites.
304.90
305.50
305.51
305.52
305.53
305.90
305.91
305.92
305.93
Coding Tips
Qualitative analysis should be identified using the appropriate code
from range 80100-80103. Codes in categories 304 Drug dependence,
and 305 Nondependent use of drugs, are reported using fifth-digit
subclassifications that more specifically describe the episode of abuse.
These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission.
This laboratory study tests for drugs that may be used in the treatment
of pain. ICD-9-CM category 338 Pain, not elsewhere classified, provides
subclassification codes that enable reporting of specific underlying
causes of pain, as well as its acuity or chronicity. Category 338 contains
an instructional note to coders to use an additional code (307.89) to
identify pain associated with psychological factors. It also contains an
exclusions note for generalized and localized pain, as well as pain
disorder exclusively attributed to psychological factors. When the
medical record documentation indicates that the patient suffered an
overdose of the drug, either accidental or as a suicide attempt, see the
Table of Drugs and Chemicals to locate the appropriate external cause
(E) code.
338.4
965.09
V58.69
Unspecified drug dependence, unspecified
Nondependent opioid abuse, unspecified
Nondependent opioid abuse, continuous
Nondependent opioid abuse, episodic
Nondependent opioid abuse, in remission
Other, mixed, or unspecified nondependent drug abuse,
unspecified
Other, mixed, or unspecified nondependent drug abuse,
continuous
Other, mixed, or unspecified nondependent drug abuse,
episodic
Other, mixed, or unspecified nondependent drug abuse,
in remission
Chronic pain syndrome — (Use additional code to identify
pain associated with psychological factors: 307.89)
Poisoning by opiates and related narcotics, other — (Use
additional code to specify the effects of poisoning)
Long-term (current) use of other medications
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
Terms To Know
qualitative. To determine the nature of the component of substance.
quantitative. To determine the amount and nature of the components of a
substance.
specimen. Tissue cells or sample of fluid taken for analysis, pathologic
examination, and diagnosis.
ICD-9-CM Diagnostic Codes
292.89
297.9
298.9
304.00
304.01
304.02
304.03
Other specified drug-induced mental disorder — (Use
additional code for any associated drug dependence:
304.0-304.9. Use additional E code to identify drug)
Unspecified paranoid state — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Unspecified psychosis — (Use additional code to identify
any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Opioid type dependence, unspecified
Opioid type dependence, continuous
Opioid type dependence, episodic
Opioid type dependence, in remission
Work Value
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
83925........................ 0.00
0.00
0.00
0.00
0.00
0.00
120
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
83992
83992
305.92
305.93
Phencyclidine (PCP)
968.3
Explanation
This test is performed to evaluate the presence of phencyclidine (also
known as PCP, or angel dust), an illegal street drug. Methodology may
include immunoassay, thin-layer chromatography (TLC), gas
chromatography (GC), and gas chromatography/mass spectrometry
(GC/TC), which quantifies the amount of drug.
Coding Tips
Qualitative analysis should be identified using the appropriate code
from range 80100-80103. Codes in categories 304 Drug dependence,
and 305 Nondependent use of drugs, are reported using fifth-digit
subclassifications that more specifically describe the episode of abuse.
These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission.
When the medical record documentation indicates that the patient
suffered an overdose of the drug, either accidental or as a suicide
attempt, see the Table of Drugs and Chemicals to locate the appropriate
external cause (E) code.
V70.4
V72.62
Other, mixed, or unspecified nondependent drug abuse,
episodic
Other, mixed, or unspecified nondependent drug abuse,
in remission
Poisoning by intravenous anesthetics — (Use additional
code to specify the effects of poisoning)
Examination for medicolegal reason — (Use additional
code(s) to identify any special screening examination(s)
performed: V73.0-V82.9)
Laboratory examination ordered as part of a routine general
medical examination
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
Terms To Know
assay. Test of purity.
CLIA. Clinical Laboratory Improvement Amendments. Requirements set in
1988, CLIA imposes varying levels of federal regulations on clinical procedures.
Few laboratories, including those in physician offices, are exempt. Adopted by
Medicare and Medicaid, CLIA regulations redefine laboratory testing in regard
to laboratory certification and accreditation, proficiency testing, quality
assurance, personnel standards, and program administration.
qualitative. To determine the nature of the component of substance.
quantitative. To determine the amount and nature of the components of a
substance.
ICD-9-CM Diagnostic Codes
292.89
297.9
298.9
304.60
304.61
304.62
304.63
305.90
305.91
Other specified drug-induced mental disorder — (Use
additional code for any associated drug dependence:
304.0-304.9. Use additional E code to identify drug)
Unspecified paranoid state — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Unspecified psychosis — (Use additional code to identify
any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Other specified drug dependence, unspecified
Other specified drug dependence, continuous
Other specified drug dependence, episodic
Other specified drug dependence, in remission
Other, mixed, or unspecified nondependent drug abuse,
unspecified
Other, mixed, or unspecified nondependent drug abuse,
continuous
Work Value
83992........................ 0.00
© 2014 OptumInsight, Inc.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.00
0.00
0.00
0.00
0.00
CPT © 2014 American Medical Association. All Rights Reserved.
121
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
84022
84022
293.82
Phenothiazine
295.70
Explanation
Derivatives of phenothiazine are numerous and most are classified as
antipsychotics. A common one is Chlorpromazine. Methods may include
high performance liquid chromatography (HPLC), thin-layer
chromatography (TLC), gas chromatography (GC) or fluorometry for
blood; thin-layer chromatography (TLC), gas-liquid chromatography
(GLC), or radioimmunoassay (RIA) for urine. The test is performed to
evaluate the amount of phenothiazine present.
295.71
295.72
Coding Tips
Qualitative analysis should be identified using the appropriate code
from range 80100–80103. To report the professional services for drug
management, see HCPCS Level II code M0064, CPT code 90863, the
appropriate level of E/M service, or the appropriate psychotherapy with
E/M service code. Follow third-party payer guidelines when selecting
the appropriate code for these services. Schizophrenia is not diagnosed
unless there is characteristic disturbance of at least two of these areas:
thought, perception, mood, conduct, and personality. The first axis of
coding schizophrenia is to identify the type (e.g., simple, disordered,
paranoid, latent, residual, etc.). Identify the course of illness with a fifth
digit, as follows: 0 Unspecified, 1 Subchronic state: continuous for more
than six months but less than two years, 2 Chronic state: continuous
for more than two years, 3 Subchronic with acute exacerbation:
continuous for more than six months but less than two years but
psychotic features have resurfaced in patient who has been in residual
phase, 4 Chronic with acute exacerbation: continuous for more than
two years but psychotic features have resurfaced in patient who has
been in residual phase and, 5 In remission: history of schizophrenia but
free from symptoms, regardless of whether patient is currently on
medication. When the medical record documentation indicates that
the patient suffered an overdose of the drug, either accidental or as a
suicide attempt, see the Table of Drugs and Chemicals to locate the
appropriate external cause (E) code.
ICD-9-CM Diagnostic Codes
292.11
292.12
293.0
293.1
293.81
Drug-induced psychotic disorder with delusions — (Use
additional code for any associated drug dependence:
304.0-304.9. Use additional E code to identify drug)
Drug-induced psychotic disorder with hallucinations —
(Use additional code for any associated drug dependence:
304.0-304.9. Use additional E code to identify drug)
Delirium due to conditions classified elsewhere — (Code
first the associated physical or neurological condition)
Subacute delirium — (Code first the associated physical or
neurological condition)
Psychotic disorder with delusions in conditions classified
elsewhere — (Code first the associated physical or
neurological condition)
Work Value
295.73
295.74
295.75
297.1
297.3
298.0
Psychotic disorder with hallucinations in conditions
classified elsewhere — (Code first the associated physical
or neurological condition)
Schizoaffective disorder, unspecified — (Use additional
code to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Schizoaffective disorder, subchronic — (Use additional
code to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Schizoaffective disorder, chronic — (Use additional code
to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Schizoaffective disorder, subchronic with acute
exacerbation — (Use additional code to identify any
associated physical disease, injury, or condition affecting
the brain with psychoses classifiable to 295-298)
Schizoaffective disorder, chronic with acute exacerbation
— (Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Schizoaffective disorder, in remission — (Use additional
code to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Delusional disorder — (Use additional code to identify any
associated physical disease, injury, or condition affecting
the brain with psychoses classifiable to 295-298)
Shared psychotic disorder — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Depressive type psychosis — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
84022........................ 0.00
0.00
0.00
0.00
0.00
0.00
122
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
84260
84260
Serotonin
296.35
Explanation
This test may also be called 5-HT or 5-Hydroxytryptamine. The specimen
is whole blood or serum or spinal fluid. Methods may include
fluorometry, radioimmunoassay (RIA), and gas or liquid
chromatography. This test may be performed to diagnose carcinoid
syndrome and severe depression.
296.36
Coding Tips
296.51
A separately reportable lumbar puncture is performed to collect
cerebrospinal fluid (CSF) specimen is reported separately, see 62270.
Episodic mood disorders (classified to category 296 in ICD-9-CM) are
recurrent, severe disturbances of mood accompanied by one or more
of the following: delusions, perplexity, disturbed attitude to self, or
disorder of perception and behavior. While subcategories identify the
type (e.g., manic or major depressive, bipolar, etc.) and episodic nature
(e.g., single, recurrent, etc.) of the disorder, the fifth-digit assignment
identifies severity of the episode. When the medical record
documentation indicates that the patient suffered an overdose of the
drug, either accidental or as a suicide attempt, see the Table of Drugs
and Chemicals to locate the appropriate external cause (E) code.
ICD-9-CM Diagnostic Codes
296.21
296.22
296.24
296.25
296.31
296.32
296.34
84260........................ 0.00
© 2014 OptumInsight, Inc.
296.54
296.55
Major depressive disorder, single episode, mild — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Major depressive disorder, single episode, moderate —
(Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Major depressive disorder, single episode, severe, specified
as with psychotic behavior — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Major depressive disorder, single episode, in partial or
unspecified remission — (Use additional code to identify
any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Major depressive disorder, recurrent episode, mild — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Major depressive disorder, recurrent episode, moderate —
(Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Major depressive disorder, recurrent episode, severe,
specified as with psychotic behavior — (Use additional
Work Value
296.52
296.56
code to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Major depressive disorder, recurrent episode, in partial or
unspecified remission — (Use additional code to identify
any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Major depressive disorder, recurrent episode, in full
remission — (Use additional code to identify any associated
physical disease, injury, or condition affecting the brain
with psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current)
depressed, mild — (Use additional code to identify any
associated physical disease, injury, or condition affecting
the brain with psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current)
depressed, moderate — (Use additional code to identify
any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current)
depressed, severe, specified as with psychotic behavior —
(Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Bipolar I disorder, most recent episode (or current)
depressed, in partial or unspecified remission — (Use
additional code to identify any associated physical disease,
injury, or condition affecting the brain with psychoses
classifiable to 295-298)
Bipolar I disorder, most recent episode (or current)
depressed, in full remission — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.00
0.00
0.00
0.00
0.00
CPT © 2014 American Medical Association. All Rights Reserved.
123
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
84600
84600
303.91
Volatiles (eg, acetic anhydride, carbon tetrachloride,
dichloroethane, dichloromethane, diethylether, isopropyl alcohol,
methanol)
303.92
Explanation
This is also known as volatile toxicology, which would include testing
for acetone, ethanol, isopropanol, and methanol. The specimen is serum
or plasma, random urine, or gastric samples (collected by gastric
lavage). Method may be gas-liquid chromatography (GLC). This test
is performed to determine systemic alcohol levels and possibly as
surveillance for drug abuse and to evaluate methanol and isopropanol
toxicity due to ingestion, inhalation, or contact.
Coding Tips
To report a test for acetaldehyde, see 82000. For the determination of
a blood alcohol level for medical or legal purposes, see 82055 for blood
alcohol; 82075 for an alcohol breath test. When the medical record
documentation indicates that the patient suffered an overdose of the
drug, either accidental or as a suicide attempt, see the Table of Drugs
and Chemicals to locate the appropriate external cause (E) code.
lavage. Washing.
specimen. Tissue cells or sample of fluid taken for analysis, pathologic
examination, and diagnosis.
venipuncture. Piercing a vein through the skin by a needle and syringe or
sharp-ended cannula or catheter to draw blood, start an intravenous infusion,
instill medication, or inject another substance such as radiopaque dye.
ICD-9-CM Diagnostic Codes
303.01
303.02
303.03
303.90
Acute alcoholic intoxication, unspecified — (Use additional
code to identify any associated condition: 291.0-291.9,
304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2,
571.3)
Acute alcoholic intoxication, continuous — (Use additional
code to identify any associated condition: 291.0-291.9,
304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2,
571.3)
Acute alcoholic intoxication, episodic — (Use additional
code to identify any associated condition: 291.0-291.9,
304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2,
571.3)
Acute alcoholic intoxication, in remission — (Use additional
code to identify any associated condition: 291.0-291.9,
304.0-304.9, 331.7, 345.0-345.9, 535.3, 571.1, 571.2,
571.3)
Other and unspecified alcohol dependence, unspecified
— (Use additional code to identify any associated condition:
291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3,
571.1, 571.2, 571.3)
Work Value
305.00
305.01
305.02
305.03
980.0
980.1
980.2
Terms To Know
303.00
303.93
982.3
982.8
987.8
Other and unspecified alcohol dependence, continuous —
(Use additional code to identify any associated condition:
291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3,
571.1, 571.2, 571.3)
Other and unspecified alcohol dependence, episodic —
(Use additional code to identify any associated condition:
291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3,
571.1, 571.2, 571.3)
Other and unspecified alcohol dependence, in remission
— (Use additional code to identify any associated condition:
291.0-291.9, 304.0-304.9, 331.7, 345.0-345.9, 535.3,
571.1, 571.2, 571.3)
Nondependent alcohol abuse, unspecified
Nondependent alcohol abuse, continuous
Nondependent alcohol abuse, episodic
Nondependent alcohol abuse, in remission
Toxic effect of ethyl alcohol — (Use additional code to
specify the nature of the toxic effect. Use additional code
to identify any associated: 291.4, 303.0, 305.0)
Toxic effect of methyl alcohol — (Use additional code to
specify the nature of the toxic effect)
Toxic effect of isopropyl alcohol — (Use additional code
to specify the nature of the toxic effect)
Toxic effect of other chlorinated hydrocarbon solvents —
(Use additional code to specify the nature of the toxic
effect)
Toxic effect of other nonpetroleum-based solvents — (Use
additional code to specify the nature of the toxic effect)
Toxic effect of other specified gases, fumes, or vapors —
(Use additional code to specify the nature of the toxic
effect)
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
84600........................ 0.00
0.00
0.00
0.00
0.00
0.00
124
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
90785
90785
ICD-9-CM Diagnostic Codes
Interactive complexity (List separately in addition to the code for
primary procedure)
Explanation
This code is reported in addition to the code for a primary psychiatric
service. It is reported when the patient being treated has certain factors
that increase the complexity of treatment rendered. These certain
factors are limited to the following: the need to manage disruptive
communication that complicates the delivery of treatment;
complications involving the implementation of a treatment plan due
to caregiver behavioral or emotional interference; evidence of a sentinel
event with subsequent disclosure to a third party and discussion and/or
reporting to the patient(s); or use of play equipment or translator to
enable communication when a barrier exists.
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
IOM References
100-2,15,60.3; 100-2,15,160; 100-2,15,170; 100-3,10.3; 100-3,10.4;
100-4,12,100; 100-4,12,210; 100-4,12,210.1
CCI Version 20.0
96150-96155
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Coding Tips
As an add-on code, 90785 is not subject to multiple procedure rules.
No reimbursement reduction or modifier 51 is applied. Add-on codes
describe additional intraservice work associated with the primary
procedure. They are performed by the same physician on the same
date of service as the primary service/procedure, and must never be
reported as stand-alone codes. Interactive complexity is to be reported
in conjunction with psychiatric evaluation services (90791-90792), the
appropriate psychotherapy code (90832, 90834, or 90837),
psychotherapy with evaluation and management service (90833, 90836,
90838), or group psychotherapy service (90853). Interactive complexity
should never be reported with psychotherapy for crisis (90839-90840)
or an evaluation and management service that was provided without
psychotherapy (90833, 90836, 90838). Documentation should clearly
indicate the type of interactive methods used such as interpreter, use
of play, or physical device used, and that the patient did not have the
ability to communicate through normal verbal means. Other catatonic
states may be covered if documentation is submitted with the claim.
Coverage also includes interactive examinations of patients with primary
psychiatric diagnoses, excluding dementias (ICD-9-CM codes
290.0-290.9), and sleep disorders (ICD-9-CM 307.40-307.49), and one
of the following conditions: 315.31 Developmental speech or language
disorder, other, 389.00-359.08 Conductive hearing loss (total), 315.39
Developmental speech or language disorder, other, 389.00-389.08
Conductive hearing loss (total), 389.2 Mixed conductive and
sensorineural hearing loss (total), 389.7 Deaf mutism, not elsewhere
classifiable, 389.8 Other specified forms of hearing loss, 784.3 Aphasia,
784.41, 784.41 Voice disturbance, aphonia, and 784.5 Other speech
disturbance (dysarthria, dysphasia).
Terms To Know
interactive psychotherapy. Use of physical aids and nonverbal
communication to overcome barriers to therapeutic interaction between a
clinician and a patient who has not yet developed or has lost either the
expressive language communication skills to explain his/her symptoms and
response to treatment, or the receptive communication skills to understand
the clinician if he or she were to use ordinary adult language for communication.
Work Value
90785........................ 0.33
© 2014 OptumInsight, Inc.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.06
0.06
0.01
0.40
0.40
CPT © 2014 American Medical Association. All Rights Reserved.
125
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
90791-90792
CCI Version 20.0
90791
Psychiatric diagnostic evaluation
90792
Psychiatric diagnostic evaluation with medical services
Explanation
A psychiatric diagnostic evaluation is the assessment of the patient's
psychosocial history, current mental status, review and ordering of
diagnostic studies followed by appropriate treatment recommendations.
In code 90792, additional medical services such as physical examination
and prescription of pharmaceuticals, are provided in addition to the
diagnostic evaluation. Interviews and communication with family
members or other sources is included in these codes.
90839-90840, 90846-90847v, 90853v, 96116, 96150-96155,
97802-97804, 99201-99255, 99281-99288, 99291-99292,
99304-99310, 99315-99318, 99324-99328, 99334-99350,
99354-99360, 99363-99368, 99374-99375, 99377-99420,
99441-99496, 99605-99606, G0270-G0271, G0380-G0384,
G0396-G0397, G0406-G0411v, G0425-G0427, G0442-G0447, G0459,
M0064
Also not with 90792: 90791
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Coding Tips
These procedures may be performed by a physician or other qualified
health care professional. Psychiatric diagnostic evaluation with or
without medical services include a history, mental status, and other
physical examination elements, the prescribing of medications and
review and ordering of laboratory or other diagnostic testing. Check
with the specific payer to determine coverage. In some cases family
members, guardians, or others may be consulted instead of the patient.
Communication factors that complicate the diagnostic evaluation results
in the need for interactive complexity (use of play equipment,
involvement of third-parties, etc.) code 90785 may be reported with
these procedures. Medical record documentation should indicate the
need for the interactive complexity services. Diagnostic evaluations
may be reported multiple times when performed during separate
encounters. These codes should not be reported on the same date of
service as an evaluation and management service or a psychotherapy
service (including psychotherapy for crisis). To report evaluation of
psychiatric hospital records reports, psychometric and/projective testing,
or other data, see code 90885. Interpretation or explanation of
psychiatric or other medical examinations and procedures is reported
using 90887. Health and behavior assessment/reassessment is reported
using 96150–96151.
Terms To Know
evaluation. Dynamic process in which the dentist makes clinical judgments
based on data gathered during the examination.
psychosocial history. Information obtained about the patient's background
regarding history of mental and physical health and social history, as well as
the status of current and past employment, finances, education, religion, stress,
and support networks including family and friends.
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
IOM References
100-1,3,30; 100-1,3,30.3; 100-2,15,170; 100-2,15,270;
100-2,15,270.2; 100-2,15,270.4; 100-3,10.3; 100-4,12,100;
100-4,12,110.3; 100-4,12,190.3; 100-4,12,190.7; 100-4,12,210;
100-4,12,210.1
Work Value
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
90791........................ 3.00
90792........................ 3.25
0.63
0.67
0.51
0.55
0.11
0.11
3.74
4.03
3.62
3.91
126
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
90832-90833
90832
Psychotherapy, 30 minutes with patient and/or family member
90833
Psychotherapy, 30 minutes with patient and/or family member
when performed with an evaluation and management service (List
separately in addition to the code for primary procedure)
psychotherapy. Treatment for mental illness and behavioral disturbances
in which the clinician establishes a professional contract with the patient and,
through definitive therapeutic communication, attempts to alleviate the
emotional disturbances, reverse or change maladaptive patterns of behavior,
and encourage personality growth and development.
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
Explanation
Psychotherapy is a variety of treatment techniques in which a physician
or other qualified health care provider helps a patient with a mental
illness or behavioral disturbance identify and alleviate any emotional
disruptions, maladaptive behavioral patterns, and
contributing/exacerbating factors. This treatment also involves
encouraging personality growth and development through coping
techniques and problem-solving skills. Report code 90832 for 16 to 37
minutes of face-to-face time spent with the patient without an additional
evaluation and management (E/M) service. Report code 90833 if a
separate E/M is performed during the same encounter as the 16 to 37
minutes of psychotherapy.
Coding Tips
These procedures may be performed by a physician or other qualified
health care professional. Check with the specific payer to determine
coverage. Site of service does not affect code assignment. As an add-on
code, 90833 is not subject to multiple procedure rules. No
reimbursement reduction or modifier 51 is applied. Add-on codes
describe additional intraservice work associated with the primary
procedure. They are performed by the same physician on the same
date of service as the primary service/procedure, and must never be
reported as stand-alone codes. The appropriate evaluation and
management service should be reported in addition to code 90833.
However, the time involved with performing the E/M service should
not be considered when selecting the psychotherapy code. If 38–52
minutes of psychotherapy are provided, see codes 90834 or 90836. If
53 or more minutes of psychotherapy are provided, see codes
90837–90838. Psychotherapy provided for an urgent assessment and
history of a crisis state, including mental status examination and
disposition is reported with 90839–90840. Family psychotherapy is
reported using 90846–90847. Multiple family or group psychotherapy
are reported using 90849 or 90853, respectively. When it is necessary
to perform interactive complexity, code 90785 may be reported
separately. Documentation should clearly state the reasons requiring
the interactive complexity. When performed during the same encounter,
management of the patient's medication(s), including review and
provision of prescription is reported separately with 90863. Do not
report prolonged services (90833–90838) with code 90833.
IOM References
100-1,3,30; 100-1,3,30.3; 100-2,15,60.3; 100-2,15,160; 100-2,15,170;
100-2,15,270; 100-2,15,270.2; 100-2,15,270.4; 100-3,10.3;
100-3,10.4; 100-3,130.3; 100-4,12,100; 100-4,12,110.3;
100-4,12,190.3; 100-4,12,190.7; 100-4,12,210; 100-4,12,210.1
CCI Version 20.0
36640, 90791-90792, 90839-90840, 90853v, 90867-90869v, 96116,
96150-96155, 97802-97804, 99281-99288, 99291-99292,
99354-99360, 99363-99368, 99374-99375, 99377-99429,
99605-99606, G0176-G0177, G0270-G0271, G0380-G0384v,
G0396-G0397, G0409-G0411v, G0442-G0447, G0459, M0064
Also not with 90832: 99201-99255, 99304-99310, 99315-99318,
99324-99328, 99334-99350, 99441-99480, 99485-99496,
G0406-G0407v
Also not with 90833: 99339-99340, 99441-99496, G0406v
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Terms To Know
face to face. Interaction between two parties, usually provider and patient,
that occurs in the physical presence of each other.
Work Value
90832........................ 1.50
90833........................ 1.50
© 2014 OptumInsight, Inc.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.25
0.29
0.23
0.28
0.06
0.06
1.81
1.85
1.79
1.84
CPT © 2014 American Medical Association. All Rights Reserved.
127
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
90834-90836
90834
Psychotherapy, 45 minutes with patient and/or family member
90836
Psychotherapy, 45 minutes with patient and/or family member
when performed with an evaluation and management service (List
separately in addition to the code for primary procedure)
psychotherapy. Treatment for mental illness and behavioral disturbances
in which the clinician establishes a professional contract with the patient and,
through definitive therapeutic communication, attempts to alleviate the
emotional disturbances, reverse or change maladaptive patterns of behavior,
and encourage personality growth and development.
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
Explanation
Psychotherapy is a variety of treatment techniques in which a physician
or other qualified health care provider helps a patient with a mental
illness or behavioral disturbance identify and alleviate any emotional
disruptions, maladaptive behavioral patterns, and
contributing/exacerbating factors. This treatment also involves
encouraging personality growth and development through coping
techniques and problem-solving skills. Report code 90834 for 38 to 52
minutes of face-to-face time spent with the patient without an additional
evaluation and management (E/M) service. Report code 90836 if a
separate E/M is performed during the same encounter as the 38 to 52
minutes of psychotherapy.
Coding Tips
These procedures may be performed by a physician or other qualified
health care professional. Check with the specific payer to determine
coverage. Site of service does not affect code assignment. As an add-on
code, 90836 is not subject to multiple procedure rules. No
reimbursement reduction or modifier 51 is applied. Add-on codes
describe additional intraservice work associated with the primary
procedure. They are performed by the same physician on the same
date of service as the primary service/procedure, and must never be
reported as stand-alone codes. The appropriate evaluation and
management (E/M) service should be reported in addition to code
90836. However, the time involved with performing the E/M service
should not be considered when selecting the psychotherapy code. If
16–37 minutes of psychotherapy are provided, see codes 90832–90833.
If 53 or more minutes of psychotherapy are provided, see codes
90837–90838. Psychotherapy provided for an urgent assessment and
history of a crisis state, including mental status examination and
disposition is reported with 90839–90840. Family psychotherapy is
reported using 90846–90847. Multiple family or group psychotherapy
are reported using 90849 or 90853, respectively. When it is necessary
to perform interactive complexity, code 90785 may be reported
separately. Documentation should clearly state the reasons requiring
the interactive complexity. When performed during the same encounter,
management of the patient's medication(s), including review and
provision of prescription is reported separately with 90863. Do not
report prolonged services (90833–90838) with code 90833.
IOM References
100-1,3,30; 100-1,3,30.3; 100-2,15,160; 100-2,15,170; 100-2,15,270;
100-2,15,270.2; 100-2,15,270.4; 100-3,10.3; 100-3,10.4; 100-3,130.3;
100-4,12,110.3; 100-4,12,190.3; 100-4,12,190.7
CCI Version 20.0
36640, 90791-90792, 90839-90840, 90853v, 90867-90869v, 96116,
96150-96155, 97802-97804, 99281-99288, 99291-99292,
99354-99360, 99363-99368, 99374-99375, 99377-99429,
99605-99606, G0176-G0177, G0270-G0271, G0380-G0384v,
G0396-G0397, G0442-G0447, G0459, M0064
Also not with 90834: 90845v, 99201-99255, 99304-99310,
99315-99318, 99324-99328, 99334-99350, 99441-99480,
99485-99496, G0406-G0411v, G0425v
Also not with 90836: 99339-99340, 99441-99496, G0406-G0407v,
G0409-G0411v
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Terms To Know
face to face. Interaction between two parties, usually provider and patient,
that occurs in the physical presence of each other.
Work Value
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
90834........................ 2.00
90836........................ 1.90
0.32
0.37
0.31
0.35
0.08
0.07
2.40
2.34
2.39
2.32
128
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
90837-90838
90837
Psychotherapy, 60 minutes with patient and/or family member
90838
Psychotherapy, 60 minutes with patient and/or family member
when performed with an evaluation and management service (List
separately in addition to the code for primary procedure)
psychotherapy. Treatment for mental illness and behavioral disturbances
in which the clinician establishes a professional contract with the patient and,
through definitive therapeutic communication, attempts to alleviate the
emotional disturbances, reverse or change maladaptive patterns of behavior,
and encourage personality growth and development.
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
Explanation
Psychotherapy is a variety of treatment techniques in which a physician
or other qualified health care provider helps a patient with a mental
illness or behavioral disturbance identify and alleviate any emotional
disruptions, maladaptive behavioral patterns, and
contributing/exacerbating factors. This treatment also involves
encouraging personality growth and development through coping
techniques and problem-solving skills. Report code 90837 for 53
minutes or more of face-to-face time spent with the patient without
an additional evaluation and management (E/M) service. Report code
90838 if a separate E/M is performed during the same encounter as
the 38 to 53 minutes of psychotherapy.
Coding Tips
These procedures may be performed by a physician or other qualified
health care professional. Check with the specific payer to determine
coverage. Site of service does not affect code assignment. As an add-on
code, 90838 is not subject to multiple procedure rules. No
reimbursement reduction or modifier 51 is applied. Add-on codes
describe additional intraservice work associated with the primary
procedure. They are performed by the same physician on the same
date of service as the primary service/procedure, and must never be
reported as stand-alone codes. The appropriate evaluation and
management service should be reported in addition to code 90838.
However, the time involved with performing the E/M service should
not be considered when selecting the psychotherapy code. If 16–37
minutes of psychotherapy are provided, see codes 90832–90833. When
38–52 minutes of psychotherapy are provided, see 90834 and 90836.
When 90 or more minutes of psychotherapy without an evaluation and
management (E/M) service is provided, report the appropriate
prolonged service code 99354–99357. Psychotherapy provided for an
urgent assessment and history of a crisis state, including mental status
examination and disposition is reported with 90839–90840. Family
psychotherapy is reported using 90846–90847. Multiple family or group
psychotherapy are reported using 90849 or 90853, respectively. When
it is necessary to perform interactive complexity code 90785 may be
reported separately. Documentation should clearly state the reasons
requiring the interactive complexity. When performed during the same
encounter, management of the patient's medication(s), including review
and provision of prescription is reported separately with 90863.
IOM References
100-1,3,30; 100-1,3,30.3; 100-2,15,160; 100-2,15,170
CCI Version 20.0
36640, 90791-90792, 90839-90840, 90845v, 90853v, 90867-90869v,
96116, 96150-96155, 97802-97804, 99281-99288, 99291-99292,
99363-99368, 99374-99375, 99377-99429, 99605-99606,
G0176-G0177, G0270-G0271, G0380-G0384v, G0396-G0397,
G0406-G0411v, G0425-G0426v, G0442-G0447, G0459, M0064
Also not with 90837: 99201-99255, 99304-99310, 99315-99318,
99324-99328, 99334-99350, 99358-99360, 99441-99480, 99485,
99487-99496
Also not with 90838: 99339-99340, 99354-99360, 99441-99496
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Terms To Know
face to face. Interaction between two parties, usually provider and patient,
that occurs in the physical presence of each other.
Work Value
90837........................ 3.00
90838........................ 2.50
© 2014 OptumInsight, Inc.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.48
0.49
0.46
0.47
0.11
0.10
3.59
3.09
3.57
3.07
CPT © 2014 American Medical Association. All Rights Reserved.
129
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
90839-90840
90839
90840
IOM References
100-1,3,30; 100-1,3,30.3; 100-2,15,170; 100-3,130.3; 100-4,12,100;
100-4,12,110.3
Psychotherapy for crisis; first 60 minutes
each additional 30 minutes (List separately in addition to code
for primary service)
Explanation
Psychotherapy is a variety of treatment techniques in which a physician
or other qualified health care provider helps a patient with a mental
illness or behavioral disturbance identify and alleviate any emotional
disruptions, maladaptive behavioral patterns, and
contributing/exacerbating factors. Report these codes when the
psychotherapy is urgent for a life-threatening or highly complex
psychiatric crisis state in a patient in distress. Code 90839 is used for
the first 30 to 74 minutes of intervention and 90840 for each additional
30 minutes. These codes include history, mental status examination,
mobilization of resources and implementation treatment.
CCI Version 20.0
36640, 90785, 90845-90853, 90865-90870, 90875-90889, 96116,
96150-96155, 97802-97804, 99605-99606, G0176-G0177,
G0270-G0271, G0396-G0397, G0442-G0447, G0459, M0064
Also not with 90839: G0409-G0411v
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Coding Tips
These procedures may be performed by a physician or other qualified
health care professional. Check with the specific payer to determine
coverage. Site of service does not affect code assignment. As an add-on
code, 90840 is not subject to multiple procedure rules. No
reimbursement reduction or modifier 51 is applied. Add-on codes
describe additional intraservice work associated with the primary
procedure. They are performed by the same physician on the same
date of service as the primary service/procedure, and must never be
reported as stand-alone codes. Documentation should indicate that
psychotherapy was provided for an urgent assessment and history of
a crisis state, including mental status examination, disposition, and that
the patient presented in a high level of distress with a complex or
life-threatening problem that required immediate attention. Time does
not have to be continuous; however, it does have to be face-to-face
with the patient, without distraction and without providing services to
another patient during the same time period. Do not report psychiatric
diagnostic evaluation codes (90791–90792) or other psychotherapy
(90832–90838) with psychotherapy for crisis services. To report
psychotherapy to patients who are not in a crisis situation, see
90832–90838. Family psychotherapy is reported using 90846–90847.
Multiple family or group psychotherapy are reported using 90849 or
90853, respectively.
Terms To Know
face to face. Interaction between two parties, usually provider and patient,
that occurs in the physical presence of each other.
psychotherapy. Treatment for mental illness and behavioral disturbances
in which the clinician establishes a professional contract with the patient and,
through definitive therapeutic communication, attempts to alleviate the
emotional disturbances, reverse or change maladaptive patterns of behavior,
and encourage personality growth and development.
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
Work Value
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
90839........................ 3.13
90840........................ 1.50
0.51
0.24
0.48
0.23
0.11
0.06
3.75
1.80
3.72
1.79
130
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
90845
90845
Psychoanalysis
Explanation
The therapist performs psychoanalysis by utilizing methods of intense
observation and analytical skills to investigate the patient's past
experiences, unconscious motivations, and internal conflicts, as well as
contributing medical conditions, to discover how these pilot the
patient's current behavior and emotions. The psychiatrist seeks to
produce change in maladapted behavior. Psychoanalysis includes
reviewing medical notes and making clinical setting arrangements,
assisting the patient in further self-awareness, working through barriers,
understanding self-observations, and modifying mental behavior and
status while continuing to elicit more information and personal
exploration. This code also includes follow-up work of documentation,
content review, and peer consultation.
Coding Tips
Psychoanalysis is reported per day. Psychoanalysis should be
differentiated from psychotherapy. Reporting this code for
psychoanalysis indicates that treatment is being provided by a physician
with the credentials to practice analytic therapy. For Medicare patients,
psychotherapy services, including psychoanalysis, are not covered if
the medical record indicates that dementia has produced a cognitive
defect severe enough to prevent establishment of a relationship allowing
therapy to be effective. Likewise, profound mental retardation
(ICD-9-CM code 318.2) never supports the medical necessity of
psychotherapy services. Codes 291.0, 291.3, and 291.81 cover the
various severity of symptoms associated with alcohol withdrawal.
ICD-9-CM has placed “Excludes” notes with these subcategories to
alert the coder that these three codes may not be used in combination
with each other. Also, the coder must use the code that describes the
highest level of symptom severity exhibited by the patient. In other
words, the hierarchy of severity is as follows: 291.0 Withdrawal with
hallucinations, delirium, delirium tremens; 291.3 Withdrawal with
hallucinosis; 291.81 Withdrawal. Idiosyncratic alcohol intoxication
(291.4) excludes acute alcohol intoxication, classified to category 305
for patients not diagnosed as having alcoholism or category 303 if
associated with alcoholism. Schizophrenia is not diagnosed unless there
is characteristic disturbance of at least two of these areas: thought,
perception, mood, conduct, and personality. The first axis of coding
schizophrenia is to identify the type (e.g., simple, disordered, paranoid,
latent, and residual, etc.). Identify the course of illness with a fifth digit,
as follows: 0 Unspecified, 1 Subchronic state: continuous for more than
six months but less than two years, 2 Chronic state: continuous for
more than two years, 3 Subchronic with acute exacerbation: continuous
for more than six months but less than two years but psychotic features
have resurfaced in patient who has been in residual phase, 4 Chronic
with acute exacerbation: continuous for more than two years but
psychotic features have resurfaced in patient who has been in residual
phase, 5 In remission: history of schizophrenia but free from symptoms,
regardless of whether patient is currently on medication. For category
296, while subcategories identify the type (e.g., manic or major
depressive, bipolar, etc.) and episodic nature (e.g., single, recurrent,
Work Value
90845........................ 2.10
© 2014 OptumInsight, Inc.
etc.) of the disorder, the fifth-digit assignment identifies severity of the
episode: 0 Unspecified, 1 Mild, 2 Moderate, 3 Severe, without mention
of psychotic behavior, 4 Severe, specified as with psychotic behavior,
and 5 In partial or unspecified remission. Subcategory 302.5
Trans-sexualism may be assigned to report a patient’s sex reassignment
surgery status, with the appropriate fourth-digit subclassification to
specify sexual history, if known. For patients with gender identity
disorder (302.85), an additional code should be reported to identify
sex reassignment surgery status (302.5x), with the appropriate
fourth-digit sexual history designation. Codes in categories 303 Alcohol
Dependence Syndrome, 304 Drug Dependence, and 305
Nondependent Use of Drugs are reported using fifth-digit
subclassifications that more specifically describe the episode of abuse.
These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission.
Terms To Know
psychoanalysis. Specific type of psychotherapy using conscious and
unconscious processes to diagnose and help patients with mild to moderate
chronic psychiatric or character problems control their life. Psychoanalysis must
be performed for appropriate patients in a one-on-one setting by a qualified
psychotherapist (MD/DO).
therapeutic. Act meant to alleviate a medical or mental condition.
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
IOM References
100-1,3,30; 100-1,3,30.3; 100-2,15,160; 100-2,15,170; 100-3,10.3;
100-3,10.4; 100-3,130.1; 100-3,130.3; 100-4,12,110.3; 100-4,12,150;
100-4,12,160; 100-4,12,160.1; 100-4,12,170; 100-4,12,170.1
CCI Version 20.0
36640, 90791-90792, 90832-90833v, 90836v, 90846-90847v,
90865v, 96116, 96150-96155, 97802-97804, 99201-99239,
99281-99285, 99291-99292, 99304-99310, 99315-99318,
99324-99328, 99334-99337, 99341-99350, 99354-99357,
99408-99409, 99605-99606, G0176-G0177, G0270-G0271,
G0380-G0384, G0396-G0397, G0406-G0408, G0425-G0427,
G0442-G0447, G0459, M0064
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.41
0.39
0.08
2.59
2.57
CPT © 2014 American Medical Association. All Rights Reserved.
131
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
90846-90849
90846
Family psychotherapy (without the patient present)
90847
Family psychotherapy (conjoint psychotherapy) (with patient
present)
90849
Multiple-family group psychotherapy
Explanation
The therapist provides family psychotherapy in a setting where the care
provider meets with the patient's family. The family is part of the patient
evaluation and treatment process. Family dynamics as they relate to
the patient’s mental status and behavior are a main focus of the sessions.
Attention is also given to the impact the patient's condition has on the
family, with therapy aimed at improving the interaction between the
patient and family members. Report 90846 when the patient is not
present. Report 90847 when the patient is present with the family;
90849 when the patient is present with his or her family as well a other
patients and families. When the patient is present, continuing evaluation
and drug management may be indicated.
Coding Tips
Determine code assignment based on if patient is present during session
or not. Family psychotherapy is covered by Medicare when the primary
purpose of such counseling is the treatment of the patient. It may be
necessary to submit the medical record documentation to substantiate
the need for family psychotherapy. Some payers require prior
authorization before covering family or group therapy services. Each
patient record must have patient specific documentation.
Documentation should include specific participation, contributions,
and reactions of each family member. See code 90853 for group
psychotherapy that does not consist of multiple families. For Medicare
patients, psychotherapy services are not covered if the medical record
indicates that dementia has produced a cognitive defect severe enough
to prevent establishment of a relationship allowing therapy to be
effective. Likewise, profound mental retardation (ICD-9-CM code 318.2)
never supports the medical necessity of psychotherapy services. Codes
291.0, 291.3, and 291.81 cover the various severities of symptoms
associated with alcohol withdrawal. ICD-9-CM has placed “Excludes”
notes with these subcategories to alert the coder that these three codes
may not be used in combination with each other. Also, the coder must
use the code that describes the highest level of symptom severity
exhibited by the patient. In other words, the hierarchy of severity is as
follows: 291.0 Withdrawal with hallucinations, delirium, delirium
tremens; 291.3 Withdrawal with hallucinosis; 291.81 Withdrawal.
Idiosyncratic alcohol intoxication (291.4) excludes acute alcohol
intoxication, classified to category 305 for patients not diagnosed as
having alcoholism or category 303 if associated with alcoholism.
Schizophrenia is not diagnosed unless there is characteristic disturbance
of at least two of these areas: thought, perception, mood, conduct,
and personality. The first axis of coding schizophrenia is to identify the
type (e.g., simple, disordered, paranoid, latent, and residual, etc.).
Identify the course of illness with a fifth digit, as follows: 0 Unspecified,
1 Subchronic state: continuous for more than six months but less than
two years, 2 Chronic state: continuous for more than two years, 3
Subchronic with acute exacerbation: continuous for more than six
Work Value
months but less than two years but psychotic features have resurfaced
in patient who has been in residual phase, 4 Chronic with acute
exacerbation: continuous for more than two years but psychotic features
have resurfaced in patient who has been in residual phase, 5 In
remission: history of schizophrenia but free from symptoms, regardless
of whether patient is currently on medication. For category 296, while
subcategories identify the type (e.g., manic or major depressive, bipolar,
etc.) and episodic nature (e.g., single, recurrent, etc.) of the disorder,
the fifth-digit assignment identifies severity of the episode: 0
Unspecified, 1 Mild, 2 Moderate, 3 Severe, without mention of psychotic
behavior, 4 Severe, specified as with psychotic behavior, 5 In partial or
unspecified remission. Subcategory 302.5 Trans-sexualism may be
assigned to report a patient’s sex reassignment surgery status, with the
appropriate fourth-digit subclassification to specify sexual history, if
known. For patients with gender identity disorder (302.85), an
additional code should be reported to identify sex reassignment surgery
status (302.5x), with the appropriate fourth-digit sexual history
designation. Codes in categories 303 Alcohol Dependence Syndrome,
304 Drug Dependence, and 305 Nondependent Use of Drugs are
reported using fifth-digit subclassifications that more specifically describe
the episode of abuse. These are: 0 Unspecified, 1 Continuous, 2
Episodic, and 3 In remission.
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
IOM References
100-1,3,30; 100-1,3,30.3; 100-2,15,160; 100-3,10.3; 100-3,10.4;
100-3,130.1; 100-3,130.3; 100-4,12,110.3; 100-4,12,150;
100-4,12,160; 100-4,12,160.1; 100-4,12,170; 100-4,12,170.1
CCI Version 20.0
90865v, 90870v, 96116, 96150-96155, 97802-97804, 99201-99239,
99281-99285, 99304-99310, 99315-99318, 99324-99328,
99334-99337, 99341-99350, 99354-99357, 99408-99409,
99605-99606, G0176-G0177, G0270-G0271, G0380-G0384,
G0396-G0397, G0442-G0447, M0064
Also not with 90846: 90847v
Also not with 90847: 36640, G0406-G0408, G0425-G0427, G0459
Also not with 90849: 90791-90792, 90845-90847v, G0406-G0408,
G0425-G0427, G0459
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
90846........................ 2.40
90847........................ 2.50
90849........................ 0.59
0.42
0.41
0.34
0.40
0.39
0.24
0.09
0.09
0.03
2.91
3.00
0.96
2.89
2.98
0.86
132
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
90853
90853
Group psychotherapy (other than of a multiple-family group)
Explanation
The psychiatric treatment provider conducts psychotherapy for a group
of several patients in one session. Group dynamics are explored.
Emotional and rational cognitive interactions between individual persons
in the group are facilitated and observed. Personal dynamics of any
individual patient may be discussed within the group setting. Processes
that help patients move toward emotional healing and modification
of thought and behavior are used, such as facilitating improved
interpersonal exchanges, group support, and reminiscing. The group
may be composed of patients with separate and distinct maladaptive
disorders or persons sharing some facet of a disorder. This code should
be used for group psychotherapy with other patients, and not members
of the patients' families.
Coding Tips
Report interactive complexity (90785) in addition to this service when
provided during the group psychotherapy session. Some payers require
prior authorization before covering family or group therapy services.
If multiple family group psychotherapy is performed, see 90849. Each
patient record must have patient-specific documentation that includes
notations of that patient’s participation, contributions, and reactions.
For Medicare patients, psychotherapy services are not covered if the
medical record indicates that dementia has produced a cognitive defect
severe enough to prevent establishment of a relationship allowing
therapy to be effective. Likewise, profound mental retardation
(ICD-9-CM code 318.2) never supports the medical necessity of
psychotherapy services. Codes 291.0, 291.3, and 291.81 cover the
various severities of symptoms associated with alcohol withdrawal.
ICD-9-CM has placed “Excludes” notes with these subcategories to
alert the coder that these three codes may not be used in combination
with each other. Also, the coder must use the code that describes the
highest level of symptom severity exhibited by the patient. In other
words, the hierarchy of severity is as follows: 291.0 Withdrawal with
hallucinations, delirium, delirium tremens; 291.3 Withdrawal with
hallucinosis; 291.81 Withdrawal. Idiosyncratic alcohol intoxication
(291.4) excludes acute alcohol intoxication, classified to category 305
for patients not diagnosed as having alcoholism or category 303 if
associated with alcoholism. Schizophrenia is not diagnosed unless there
is characteristic disturbance of at least two of these areas: thought,
perception, mood, conduct, and personality. The first axis of coding
schizophrenia is to identify the type (e.g., simple, disordered, paranoid,
latent, and residual, etc.). Identify the course of illness with a fifth digit,
as follows: 0 Unspecified, 1 Subchronic state: continuous for more than
six months but less than two years, 2 Chronic state: continuous for
more than two years, 3 Subchronic with acute exacerbation: continuous
for more than six months but less than two years but psychotic features
have resurfaced in patient who has been in residual phase, 4 Chronic
with acute exacerbation: continuous for more than two years but
psychotic features have resurfaced in patient who has been in residual
phase, 5 In remission: history of schizophrenia but free from symptoms,
regardless of whether patient is currently on medication. For category
Work Value
90853........................ 0.59
© 2014 OptumInsight, Inc.
296, while subcategories identify the type (e.g., manic or major
depressive, bipolar, etc.) and episodic nature (e.g., single, recurrent,
etc.) of the disorder, the fifth-digit assignment identifies severity of the
episode: 0 Unspecified, 1 Mild, 2 Moderate, 3 Severe, without mention
of psychotic behavior, 4 Severe, specified as with psychotic behavior,
5 In partial or unspecified remission. Subcategory 302.5 Trans-sexualism
may be assigned to report a patient’s sex reassignment surgery status,
with the appropriate fourth-digit subclassification to specify sexual
history, if known. For patients with gender identity disorder (302.85),
an additional code should be reported to identify sex reassignment
surgery status (302.5X), with the appropriate fourth-digit sexual history
designation. Codes in categories 303 Alcohol Dependence Syndrome,
304 Drug Dependence, and 305 Nondependent Use of Drugs, are
reported using fifth-digit subclassifications that more specifically describe
the episode of abuse. These are: 0 Unspecified, 1 Continuous, 2
Episodic, and 3 In remission.
Terms To Know
cognitive. Being aware by drawing from knowledge, such as judgment,
reason, perception, and memory.
preauthorization. Requirement that approval for requested services be
obtained before providing those services.
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
IOM References
100-1,3,30; 100-1,3,30.3; 100-2,15,160; 100-3,10.3; 100-3,10.4;
100-3,130.1; 100-3,130.3; 100-4,12,110.3; 100-4,12,150;
100-4,12,160; 100-4,12,160.1; 100-4,12,170; 100-4,12,170.1
CCI Version 20.0
36640, 90845-90849v, 90865v, 90870v, 96116, 96150-96155,
97802-97804, 99201-99239, 99281-99285, 99291-99292,
99307-99310, 99315-99318, 99324-99328, 99334-99337,
99341-99350, 99354-99357, 99408-99409, 99605-99606,
G0176-G0177, G0270-G0271, G0380-G0384, G0396-G0397,
G0406-G0408, G0425-G0427, G0442-G0447, G0459, M0064
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.12
0.10
0.03
0.74
0.72
CPT © 2014 American Medical Association. All Rights Reserved.
133
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
90863
90863
IOM References
Pharmacologic management, including prescription and review
of medication, when performed with psychotherapy services (List
separately in addition to the code for primary procedure)
100-2,15,160; 100-2,15,170; 100-3,10.3; 100-3,10.4; 100-4,12,110.3;
100-4,12,210; 100-4,12,210.1
CCI Version 20.0
96150-96155
Explanation
This code describes the psychiatric services of managing the patient’s
medications, including the patient’s current use of the medicines, a
medical review of the benefits and treatment progression, management
of side effects, and review or change of prescription. This is a
pharmacologically related service and is reported in addition to
non-crisis related psychotherapy when there is no other evaluation and
management performed during the encounter.
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Coding Tips
This procedure may be performed by a physician or other qualified
health care professional. Check with the specific payer to determine
coverage. Site of service does not affect code assignment. As an add-on
code, 90863 is not subject to multiple procedure rules. No
reimbursement reduction or modifier 51 is applied. Add-on codes
describe additional intraservice work associated with the primary
procedure. They are performed by the same physician on the same
date of service as the primary service/procedure, and must never be
reported as stand-alone codes. The appropriate psychotherapy code
without E/M service (90832, 90834, or 90837) should be reported in
addition to code 90838. When determining the appropriate
psychotherapy code to be reported with this procedure, any time spent
providing the medication management should be excluded. For
example, if the patient is seen for 45 minutes, and 15 minutes is spent
performing medication management, code 90832 Psychotherapy, 30
minutes with patient and/or family, and code 90863 are reported. This
code should not be reported with an evaluation and management code
as the service is included as part of the E/M code. Medical record
documentation should include the medication prescribed, condition
for which the medication is needed, dosage, directions for use, any
frequent side effects, the effect the medication is having on the patient's
symptoms or conditions, and any changes or continuation of
medications. HCPCS Level II code M0064 should be used in lieu of
90863 when required by the payer and when the encounter is brief
(usually fewer than 15 minutes) for the sole purpose of refilling the
medication.
Terms To Know
evaluation and management. Assessment, counseling, and other services
provided to a patient reported through CPT codes.
psychotherapy. Treatment for mental illness and behavioral disturbances
in which the clinician establishes a professional contract with the patient and,
through definitive therapeutic communication, attempts to alleviate the
emotional disturbances, reverse or change maladaptive patterns of behavior,
and encourage personality growth and development.
ICD-9-CM Diagnostic Codes
This is an add-on code. Refer to the corresponding primary procedure
code for ICD-9-CM diagnosis code links.
Work Value
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
90863........................ 0.00
0.00
0.00
0.00
0.00
0.00
134
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
90865
90865
Narcosynthesis for psychiatric diagnostic and therapeutic purposes
(eg, sodium amobarbital (Amytal) interview)
Explanation
A hypnotic drug known as Amytal or sodium amobarbital is infused
into the patient via an intravenous drip for psychiatric diagnostic or
psychotherapeutic treatment purposes. Amytal is a hypnotic sedative
used for diagnosing dissociative disorders and to treat trauma victims
by accessing repressed memories, emotions, or events to facilitate
healing. This is often used after other measures have failed and/or when
gaining a definitive diagnosis is medically essential. A sodium Amytal
interview is often conducted in an inpatient setting, to monitor the
effects of the drug. The patient is in a hypnotic state, where memories,
as the patient perceives them, are more confidently reviewed. These
interviews are often videotaped for later discussion.
Coding Tips
Medical record documentation should indicate the type of medications
used as well as the dosage administered in addition to the findings
during the examination. Most third-party payers feel that ICD-9-CM
codes 290.0–305.0 and 305.2–319 support the medical necessity of
this service. This code is only to be used by physicians (MD/DO).
Alcohol-induced mental disorders (category 291) are psychoses resulting
from excessive alcohol consumption, usually associated with nutritional
deficits. This category excludes alcoholism without psychosis, which is
classified to category 303. However, when alcohol dependence or abuse
results in a psychotic condition, code both the psychotic condition and
the dependence (303.xx) or abuse (305.0x). Codes 291.0, 291.3, and
291.81 cover the various severity of symptoms associated with alcohol
withdrawal. ICD-9-CM has placed “Excludes” notes with these
subcategories to alert the coder that these three codes may not be
used in combination with each other. Also, the coder must use the
code that describes the highest level of symptom severity exhibited by
the patient. In other words, the hierarchy of severity is as follows: 291.0
Withdrawal with hallucinations, delirium, delirium tremens; 291.3
Withdrawal with hallucinosis; 291.81 Withdrawal. Idiosyncratic alcohol
intoxication (291.4) excludes acute alcohol intoxication, classified to
category 305 for patients not diagnosed as having alcoholism or
category 303 if associated with alcoholism. Schizophrenia is not
diagnosed unless there is characteristic disturbance of at least two of
these areas: thought, perception, mood, conduct, and personality. The
first axis of coding schizophrenia is to identify the type (e.g., simple,
disordered, paranoid, latent, and residual, etc.). Identify the course of
illness with a fifth digit, as follows: 0 Unspecified, 1 Subchronic state:
continuous for more than six months but less than two years, 2 Chronic
state: continuous for more than two years, 3 Subchronic with acute
exacerbation: continuous for more than six months but less than two
years but psychotic features have resurfaced in patient who has been
in residual phase, 4 Chronic with acute exacerbation: continuous for
more than two years but psychotic features have resurfaced in patient
who has been in residual phase, 5 In remission: history of schizophrenia
but free from symptoms, regardless of whether patient is currently on
medication. For category 296, while subcategories identify the type
Work Value
90865........................ 2.84
© 2014 OptumInsight, Inc.
(e.g., manic or major depressive, bipolar, etc.) and episodic nature
(e.g., single, recurrent, etc.) of the disorder, the fifth-digit assignment
identifies severity of the episode: 0 Unspecified, 1 Mild, 2 Moderate, 3
Severe, without mention of psychotic behavior, 4 Severe, specified as
with psychotic behavior, and 5 In partial or unspecified remission.
Subcategory 302.5 Trans-sexualism may be assigned to report a
patient’s sex reassignment surgery status, with the appropriate
fourth-digit subclassification to specify sexual history, if known. For
patients with gender identity disorder (302.85), an additional code
should be reported to identify sex reassignment surgery status (302.5x),
with the appropriate fourth-digit sexual history designation. Codes in
categories 303 Alcohol Dependence Syndrome, 304 Drug Dependence,
and 305 Nondependent Use of Drugs are reported using fifth-digit
subclassifications that more specifically describe the episode of abuse.
These are: 0 Unspecified, 1 Continuous, 2 Episodic, and 3 In remission.
Code 309.81 should be used to report post traumatic stress disorder
(PTSD).
Terms To Know
amobarbital. Barbiturate causing central nervous system depression with
sedative hypnotic and anticonvulsant properties as well. Amytal is the trade
name. Injectable amobarbital described by HCPCS Level II code J0300 is for
the parenteral drug administered by IV and is frequently used as an IV sedative
preoperatively or in abreaction psychotherapy. May be sold under the brand
name Amytal.
therapeutic. Act meant to alleviate a medical or mental condition.
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
IOM References
100-1,3,30; 100-1,3,30.1; 100-1,3,30.3; 100-2,15,160; 100-2,15,170;
100-4,12,150; 100-4,12,160; 100-4,12,160.1; 100-4,12,170;
100-4,12,170.1; 100-4,12,210; 100-4,12,210.1
CCI Version 20.0
90791-90792, 90832-90834v, 90836-90838v, 96116, 96150-96155,
97802-97804, 99201-99239, 99281-99285, 99291-99292,
99304-99310, 99315-99318, 99324-99328, 99334-99337,
99341-99350, 99354-99357, 99605-99606, G0270-G0271,
G0380-G0384, G0406-G0408, G0425-G0427, G0444-G0447, G0459,
M0064
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
1.78
0.66
0.11
4.73
3.61
CPT © 2014 American Medical Association. All Rights Reserved.
135
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
90867-90869
90867
CCI Version 20.0
Therapeutic repetitive transcranial magnetic stimulation (TMS)
treatment; initial, including cortical mapping, motor threshold
determination, delivery and management
90868
subsequent delivery and management, per session
90869
subsequent motor threshold re-determination with delivery
and management
0333T, 12001-12007, 12011-12057, 13100-13133, 13151-13153,
90845-90853v, 90865v, 90880v, 95860-95870, 95907-95913,
95925-95930, 95938-95939, 96150-96155, 99201-99255,
99281-99285, 99291-99292, 99304-99310, 99315-99318,
99324-99328, 99334-99337, 99341-99350, 99374-99375,
99377-99378, 99446-99449, 99495-99496, G0410-G0411v,
G0444-G0447, G0459, M0064
Also not with 90867: 90868-90870v
Also not with 90868: 90870v
Explanation
Transcranial magnetic stimulation (TMS) is a technique to stimulate
the brain by electromagnetic induction with a coil placed on the scalp.
For direct stimulation to cortical neurons, a strong magnetic field pulse
is generated over the patient's scalp to activate cortical neurons in the
brain and to disturb the normal operation of the brain. Report 90867
for the initial treatment session, including cortical mapping, motor
threshold determination, delivery, and management. Report 90868 for
each subsequent session, including delivery and management only.
Report 90869 for a subsequent session in which the motor threshold
is re-determined and delivery and management are performed.
Also not with 90869: 90868, 90870v, 99354-99357, 99406-99407,
99455-99480, 99485
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Coding Tips
Report 90867 for the initial session and 90868 for any subsequent
sessions. When subsequent redetermination is performed only 90869
should be reported. Medical record documentation should indicate
the nature and extent of the transcranial magnetic stimulation (TMS)
planning. Do not report 90867 in conjunction with needle EMG
procedures (95860–95870) or transcranial motor stimulation of upper
or lower limbs (95928, 95829 or 95839). The delivery of TMS may be
reported once per session with code 90867, 90868, or 90869. When
documentation supports that a significant, separately identifiable
evaluation and management (E/M) service was rendered the appropriate
code for the E/M service may be reported additionally. Medication
management (90863) or psychotherapy (90832–90840) may also be
coded separately when supported by documentation.
Terms To Know
depression. Disproportionate depressive state with behavior disturbance
that is usually the result of a distressing experience and may include
preoccupation with the psychic trauma and anxiety.
schizophrenia. Fundamental disturbance of personality and characteristic
distortion of thinking, often a sense of being controlled by alien forces,
delusions, disturbed perception, abnormal affect out of keeping with the real
situation, and auditory or visual hallucinations with fear that intimate thoughts,
feelings, and acts are known by others although clear consciousness and
intellectual capacity are usually maintained.
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
Work Value
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
90867........................ 0.00
90868........................ 0.00
90869........................ 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
136
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
90870
90870
296.33
Electroconvulsive therapy (includes necessary monitoring)
Explanation
The treating clinician initiates a seizure using electroconvulsive therapy
(ECT), most often to combat chronic or profound depression, especially
psychotic or intractable manic forms and used for people who cannot
take antidepressants. The clinician anesthetizes the patient with a
barbiturate and a muscle relaxant. Electrodes are placed on the patient's
temples and/or forehead and a measured electrical dose is applied for
about a second to commence the seizure, typically lasting 30 seconds
to a minute. EEG and EKG monitors follow the seizure activity and heart
rhythm while the patient sleeps through the therapy. The patient
awakens a few minutes later.
Coding Tips
According to the AMA, this code includes the management of the
seizures by EEG, observation of the patient and decision making
regarding further treatment. The AMA goes further stating that if the
psychiatrist also administers the anesthesia for the therapy, the
appropriate anesthesia code (00104) should be coded in addition.
However, most third-party payers, including Medicare, will not
reimburse the physician performing the procedure separately for
anesthesia services. For category 296—while subcategories identify the
type (e.g., manic or major depressive, bipolar, etc.) and episodic nature
(e.g., single, recurrent, etc.) of the disorder, the fifth-digit assignment
identifies severity of the episode: 0 Unspecified, 1 Mild, 2 Moderate, 3
Severe, without mention of psychotic behavior, 4 Severe, specified as
with psychotic behavior, and 5 In partial or unspecified remission.
Terms To Know
chronic. Persistent, continuing, or recurring.
depression. Disproportionate depressive state with behavior disturbance
that is usually the result of a distressing experience and may include
preoccupation with the psychic trauma and anxiety.
electrode. Electric terminal specialized for a particular electrochemical reaction
that acts as a medium between a body surface and another instrument,
commonly termed a lead.
296.35
311
Major depressive disorder, recurrent episode, severe,
without mention of psychotic behavior — (Use additional
code to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Major depressive disorder, recurrent episode, in partial or
unspecified remission — (Use additional code to identify
any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Depressive disorder, not elsewhere classified
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
IOM References
100-1,3,30.1; 100-2,15,160; 100-2,15,170; 100-4,12,150;
100-4,12,160; 100-4,12,160.1; 100-4,12,170; 100-4,12,170.1;
100-4,12,210; 100-4,12,210.1
CCI Version 20.0
00104, 0213T, 0216T, 0228T, 0230T, 12001-12007, 12011-12057,
13100-13133, 13151-13153, 36000, 36400-36410, 36420-36430,
36440, 36600, 36640, 37202, 43752, 51701-51703, 62310-62319,
64400-64435, 64445-64450, 64479, 64483, 64490, 64493,
64505-64530, 90791-90792, 90832-90834v, 90836-90838v, 90845v,
90865v, 90880v, 93000-93010, 93040-93042, 93318, 94002, 94200,
94250, 94680-94690, 94770, 95812-95816, 95819, 95822, 95829,
95955, 96150-96360, 96365, 96372, 96374-96376, 97802-97804,
99148-99149, 99150, 99211-99223, 99231-99255, 99291-99292,
99304-99310, 99315-99316, 99334-99337, 99347-99350,
99374-99375, 99377-99378, 99446-99449, 99495-99496,
99605-99606, G0270-G0271, G0444-G0447, G0459, M0064
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
ICD-9-CM Diagnostic Codes
296.24
296.25
296.30
Major depressive disorder, single episode, severe, specified
as with psychotic behavior — (Use additional code to
identify any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Major depressive disorder, single episode, in partial or
unspecified remission — (Use additional code to identify
any associated physical disease, injury, or condition
affecting the brain with psychoses classifiable to 295-298)
Major depressive disorder, recurrent episode, unspecified
— (Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Work Value
90870........................ 2.50
© 2014 OptumInsight, Inc.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
2.37
0.53
0.11
4.98
3.14
CPT © 2014 American Medical Association. All Rights Reserved.
137
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
90875-90876
90875
90876
Individual psychophysiological therapy incorporating biofeedback
training by any modality (face-to-face with the patient), with
psychotherapy (eg, insight oriented, behavior modifying or
supportive psychotherapy); 30 minutes
45 minutes
Explanation
The treating clinician gives individual psychophysiological therapy by
utilizing biofeedback training together with psychotherapy to modify
behavior. The clinician prepares the patient with sensors that read and
display skin temperature, blood pressure, muscle tension, or brain wave
activity. The patient is taught how certain thought processes, stimuli,
and actions affect these physiological responses. The treating clinician
works with the patient to learn to recognize and manipulate these
responses, to control maladapted physiological functions, through
relaxation and awareness techniques. Psychotherapy is also rendered
using supportive interactions, suggestion, persuasion, reality discussions,
re-education, behavior modification techniques, reassurance, and the
occasional aid of medication. Individual psychophysiological therapy
is performed face to face with the patient. Report 90875 for sessions
of 30 minutes and 90876 for sessions of 45 minutes.
Coding Tips
These procedures may be performed by a physician or other qualified
health care professional. Check with the specific payer to determine
coverage. Most third-party payers, including Medicare, do not provide
coverage of biofeedback therapy when used to treat psychiatric
conditions. Schizophrenia is not diagnosed unless there is characteristic
disturbance of at least two of these areas: thought, perception, mood,
conduct, and personality. The first axis of coding schizophrenia is to
identify the type (e.g., simple, disordered, paranoid, latent, residual,
etc.). Identify the course of illness with a fifth digit, as follows: 0
Unspecified, 1 Subchronic state: continuous for more than six months
but less than two years, 2 Chronic state: continuous for more than two
years, 3 Subchronic with acute exacerbation: continuous for more than
six months but less than two years but psychotic features have
resurfaced in patient who has been in residual phase, 4 Chronic with
acute exacerbation: continuous for more than two years but psychotic
features have resurfaced in patient who has been in residual phase, and
5 In remission: history of schizophrenia but free from symptoms,
regardless of whether patient is currently on medication. For category
296, while subcategories identify the type (e.g., manic or major
depressive, bipolar, etc.) and episodic nature (e.g., single, recurrent,
etc.) of the disorder, the fifth-digit assignment identifies severity of the
episode: 0 Unspecified, 1 Mild, 2 Moderate, 3 Severe, without mention
of psychotic behavior, 4 Severe, specified as with psychotic behavior,
and 5 In partial or unspecified remission. Subcategory 302.5
Trans-sexualism may be assigned to report a patient’s sex reassignment
surgery status, with the appropriate fourth-digit subclassification to
specify sexual history, if known. For patients with gender identity
disorder (302.85), an additional code should be reported to identify
sex reassignment surgery status (302.5X), with the appropriate
fourth-digit sexual history designation. Codes in categories 303 Alcohol
Work Value
dependence syndrome, 304 Drug dependence, and 305 Nondependent
use of drugs, are reported using fifth-digit subclassifications that more
specifically describe the episode of abuse. These are: 0 Unspecified, 1
Continuous, 2 Episodic, and 3 In remission. Physiological malfunction
arising from mental factors includes functional disturbances or
interruptions due to mental or psychological causes. There is no tissue
damage sustained in these conditions. If there is tissue damage, see
category 306. Also excluded from this category are dissociative
conversion, and factitious disorders (300.11–300.19) and specific
nonpsychotic mental disorders following organic brain damage
(310.0–310.9). Subcategories are organized by organ system
involvement: Musculoskeletal (306.0), Respiratory (306.1),
Cardiovascular (306.2), Skin (306.3), Gastrointestinal (306.4),
Genitourinary (306.5), Endocrine (306.6), Organs of special sense
(306.7), Other specified psychophysiological malfunction, unspecified
(306.8), Unspecified psychophysiological malfunction (306.9). For
subcategory 306.5, one of the following fifth-digit subclassifications
must be assigned: 306.50 Psychogenic genitourinary malfunction,
unspecified; 306.51 Psychogenic vaginismus; 306.52 Psychogenic
dysmenorrhea; 306.53 Psychogenic dysuria; 306.59 Other. Category
307 is intended for use if the psychopathology is manifested by a single
specific symptom or a group of symptoms, which are not part of an
organic illness or other mental disorder classifiable elsewhere. Included
in this category are the following subcategories: Stuttering (307.0),
Anorexia nervosa (307.1), Tics (307.2), Stereotypic movement disorder
(307.3), Specific disorders of sleep of nonorganic origin (307.4), Other
and unspecified disorders of eating (307.5), Enuresis (307.6), Encopresis
(307.7), Pain disorders related to psychological factors (307.8), Other
and unspecified special symptoms or syndromes (307.9). Some sleep
disorders are not due to a substance or known physiological or
pathological condition. These disorders are classified as having a
nonorganic origin (307.4X). These include conditions of
psychophysiological origin, disturbance in sleep environment,
paradoxical conditions that exhibit seemingly contradictable aspects
and/or idiopathic conditions that are self-originated or of unknown
etiology.
Terms To Know
psychophysiological disorders. Various physical symptoms or types of
physiological malfunctions of mental origin, usually manifested in the autonomic
nervous system.
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
IOM References
100-1,3,30.1; 100-2,15,160; 100-2,15,170; 100-3,10.4; 100-4,12,150;
100-4,12,160; 100-4,12,160.1; 100-4,12,170; 100-4,12,170.1;
100-4,12,210; 100-4,12,210.1
CCI Version 20.0
96150-96155
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
90875........................ 1.20
90876........................ 1.90
0.47
1.03
0.46
0.73
0.08
0.11
1.75
3.04
1.74
2.74
138
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
90880
90880
IOM References
100-1,3,30; 100-1,3,30.1; 100-1,3,30.3; 100-2,15,160; 100-2,15,170;
100-4,12,150; 100-4,12,160; 100-4,12,160.1; 100-4,12,170;
100-4,12,170.1; 100-4,12,210; 100-4,12,210.1
Hypnotherapy
Explanation
Hypnosis is used as a modality for psychotherapy. The therapist induces
an altered state of consciousness, or focused attention, in the patient.
While patients are in this relaxed state of heightened awareness and
suggestibility, they can experience changes in the way they feel, think,
and behave in response to suggestions directed to them by the
hypnotherapist. This modality for psychiatric services helps the therapist
to achieve an alteration in the patient’s thought and behavior patterns.
Coding Tips
This procedure may be performed by a physician or other qualified
health care professional. Check with the specific payer to determine
coverage. Most third-party payers coverage of hypnotherapy is
conditional and dependent upon the condition necessitating the service.
Some examples of covered conditions and their corresponding
ICD-9-CM codes are: Conversion disorder (300.11), Dissociative amnesia
(300.12), Dissociative fugue (300.13), Multiple personality disorders
(300.14), Phobic disorders (300.20–300.29), Psychogenic pain
(307.80–307.89), Stress disorder (308.0–309.9). Code 309.81 should
be used to report post-traumatic stress disorder (PTSD). When
hypnotherapy is used in conjunction with psychotherapy (to increase
the state of suggestibility) only code 90880, hypnotherapy, should be
reported.
CCI Version 20.0
90791-90792, 90832-90834, 90836-90838, 90845-90853, 90865v,
96116, 96150-96155, 97802-97804, 99201-99239, 99281-99285,
99291-99292, 99304-99310, 99315-99318, 99324-99328,
99334-99337, 99341-99350, 99354-99357, 99408-99409,
G0176-G0177, G0270-G0271, G0380-G0384, G0396-G0397,
G0406-G0408, G0410-G0411, G0425-G0427, G0442-G0447
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Terms To Know
psychogenic fugue. Rapid onset form of dissociative hysteria characterized
by an episode of wandering with the inability to recall one's prior identity,
followed by a quick recovery and no recollection of events that took place
during the fugue state.
psychotherapy. Treatment for mental illness and behavioral disturbances
in which the clinician establishes a professional contract with the patient and,
through definitive therapeutic communication, attempts to alleviate the
emotional disturbances, reverse or change maladaptive patterns of behavior,
and encourage personality growth and development.
stress reaction, acute. Acute transient disorders of any severity and nature
of emotions, consciousness, and psychomotor states (singly or in combination)
that occur in individuals, without any apparent pre-existing mental disorder,
in response to exceptional physical or mental stress, such as natural catastrophe
or battle, and that usually subside within hours or days.
stress reaction, chronic. Abnormal or maladaptive reaction with emotional
or behavioral characteristics as a result of a life event or stressor that is usually
temporary.
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
Work Value
90880........................ 2.19
© 2014 OptumInsight, Inc.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.58
0.38
0.08
2.85
2.65
CPT © 2014 American Medical Association. All Rights Reserved.
139
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
90882
90882
Environmental intervention for medical management purposes
on a psychiatric patient's behalf with agencies, employers, or
institutions
Explanation
The clinician uses this code to report work done with agencies,
employers, or institutions on a psychiatric patient's behalf in order to
achieve environmental changes and interventions for managing the
patient’s medical condition.
Coding Tips
This procedure may be performed by a physician or other qualified
health care professional. Check with the specific payer to determine
coverage. Medicare and most third-party payers do not reimburse for
this service.
Terms To Know
intervention. Purposeful interaction of the physical therapist with the patient
and, when appropriate, with other individuals involved in patient care, using
various physical therapy procedures and techniques to produce changes in the
condition.
noncovered procedure. Health care treatment not reimbursable according
to provisions of a given insurance policy, or in the case of Medicare, in
accordance with Medicare laws and regulations.
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
IOM References
100-2,15,170; 100-4,12,210; 100-4,12,210.1
CCI Version 20.0
96150-96155
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Work Value
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
90882........................ 0.00
0.00
0.00
0.00
0.00
0.00
140
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
90885
90885
Psychiatric evaluation of hospital records, other psychiatric reports,
psychometric and/or projective tests, and other accumulated data
for medical diagnostic purposes
Explanation
The clinician reviews and evaluates the patient's hospital records, other
psychiatric reports such as psychometric and projective tests, and other
pertinent data for the purpose of gaining a medical diagnosis and
insight into the patient's present condition.
Coding Tips
This procedure may be performed by a physician or other qualified
health care professional. Check with the specific payer to determine
coverage. This service indicates the evaluation of hospital records, other
psychiatric reports, diagnostic tests, or other data to diagnosis the
patient's condition. If this interpretation is provided on the day that
the physician is providing other services, an E/M code may be more
appropriate. In the case of an encounter where evaluation and
psychotherapy were performed, the appropriate psychotherapy code
that includes the E/M service should be used. Very few third-party
payers provide coverage of this service. In the case of reports provided
at an agency's or employer's request, a fee should be discussed and
payment arrangement made prior to the rendering of the service. Codes
291.0, 291.3, and 291.81 cover the various severity of symptoms
associated with alcohol withdrawal. ICD-9-CM has placed “Excludes”
notes with these subcategories to alert the coder that these three codes
may not be used in combination with each other. Also, the coder must
use the code that describes the highest level of symptom severity
exhibited by the patient. In other words, the hierarchy of severity is as
follows: 291.0 Withdrawal with hallucinations, delirium, delirium
tremens; 291.3 Withdrawal with hallucinosis; 291.81 Withdrawal.
Idiosyncratic alcohol intoxication (291.4) excludes acute alcohol
intoxication, classified to category 305 for patients not diagnosed as
having alcoholism or category 303 if associated with alcoholism.
Schizophrenia is not diagnosed unless there is characteristic disturbance
of at least two of these areas: thought, perception, mood, conduct,
and personality. The first axis of coding schizophrenia is to identify the
type (e.g., simple, disordered, paranoid, latent, residual, etc.). Identify
the course of illness with a fifth digit, as follows: 0 Unspecified, 1
Subchronic state: continuous for more than six months but less than
two years, 2 Chronic state: continuous for more than two years, 3
Subchronic with acute exacerbation: continuous for more than six
months but less than two years but psychotic features have resurfaced
in patient who has been in residual phase, 4 Chronic with acute
exacerbation: continuous for more than two years but psychotic features
have resurfaced in patient who has been in residual phase, and 5 In
remission: history of schizophrenia but free from symptoms, regardless
of whether patient is currently on medication. For category 296, while
subcategories identify the type (e.g., manic or major depressive, bipolar,
etc.) and episodic nature (e.g., single, recurrent, etc.) of the disorder,
the fifth-digit assignment identifies severity of the episode: 0
Unspecified, 1 Mild, 2 Moderate, 3 Severe, without mention of psychotic
behavior, 4 Severe, specified as with psychotic behavior, and 5 In partial
Work Value
90885........................ 0.97
© 2014 OptumInsight, Inc.
or unspecified remission. Subcategory 302.5 Trans-sexualism may be
assigned to report a patient’s sex reassignment surgery status, with the
appropriate fourth-digit subclassification to specify sexual history, if
known. For patients with gender identity disorder (302.85), an
additional code should be reported to identify sex reassignment surgery
status (302.5X), with the appropriate fourth-digit sexual history
designation. Codes in categories 303 Alcohol Dependence Syndrome,
304 Drug Dependence, and 305 Nondependent Use of Drugs are
reported using fifth-digit subclassifications that more specifically describe
the episode of abuse. These are: 0 Unspecified, 1 Continuous, 2
Episodic, and 3 In remission.
Terms To Know
diagnosis. Determination or confirmation of a condition, disease, or syndrome
and its implications.
evaluation and management. Assessment, counseling, and other services
provided to a patient reported through CPT codes.
noncovered procedure. Health care treatment not reimbursable according
to provisions of a given insurance policy, or in the case of Medicare, in
accordance with Medicare laws and regulations.
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
IOM References
100-1,3,30.1; 100-2,15,160; 100-2,15,170; 100-4,12,150;
100-4,12,160; 100-4,12,160.1; 100-4,12,170; 100-4,12,170.1;
100-4,12,210; 100-4,12,210.1
CCI Version 20.0
96150-96155
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.37
0.37
0.07
1.41
1.41
CPT © 2014 American Medical Association. All Rights Reserved.
141
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
90887
90887
Interpretation or explanation of results of psychiatric, other medical
examinations and procedures, or other accumulated data to family
or other responsible persons, or advising them how to assist patient
Explanation
The clinician interprets the results of a patient’s psychiatric and medical
examinations and procedures, as well as any other pertinent recorded
data, and spends time explaining the patient's condition to family
members and other responsible parties involved with the patient’s care
and well-being. Advice is also given as to how family members can best
assist the patient.
Coding Tips
This procedure may be performed by a physician or other qualified
health care professional. Check with the specific payer to determine
coverage. This service indicates that the physician has explained to the
patient’s family, care taker, or to the patient’s employer, the medical
examinations, procedures, and other accumulated data performed on
that patient in order to obtain the responsible parties participation
and/or support in that patient's treatment. If this interpretation is
provided on the day that the physician is providing other services, an
E/M code may be more appropriate. In the case of an encounter where
evaluation and psychotherapy were performed, the appropriate
psychotherapy code that includes the E/M service should be used. It
should be noted that very few third-party payers provide coverage for
this service. In the case of reports provided at an agency's or employer's
request, a fee should be discussed and payment arrangement made
prior to the rendering of the service. Codes 291.0, 291.3, and 291.81
cover the various severity of symptoms associated with alcohol
withdrawal. ICD-9-CM has placed “Excludes” notes with these
subcategories to alert the coder that these three codes may not be
used in combination with each other. Also, the coder must use the
code that describes the highest level of symptom severity exhibited by
the patient. In other words, the hierarchy of severity is as follows: 291.0
Withdrawal with hallucinations, delirium, delirium tremens; 291.3
Withdrawal with hallucinosis; 291.81 Withdrawal. Idiosyncratic alcohol
intoxication (291.4) excludes acute alcohol intoxication, classified to
category 305 for patients not diagnosed as having alcoholism or
category 303 if associated with alcoholism. Schizophrenia is not
diagnosed unless there is characteristic disturbance of at least two of
these areas: thought, perception, mood, conduct, and personality. The
first axis of coding schizophrenia is to identify the type (e.g., simple,
disordered, paranoid, latent, residual, etc.). Identify the course of illness
with a fifth digit, as follows: 0 Unspecified, 1 Subchronic state:
continuous for more than six months but less than two years, 2 Chronic
state: continuous for more than two years, 3 Subchronic with acute
exacerbation: continuous for more than six months but less than two
years but psychotic features have resurfaced in patient who has been
in residual phase, 4 Chronic with acute exacerbation: continuous for
more than two years but psychotic features have resurfaced in patient
who has been in residual phase, and 5 In remission: history of
schizophrenia but free from symptoms, regardless of whether patient
is currently on medication. For category 296, while subcategories
Work Value
identify the type (e.g., manic or major depressive, bipolar, etc.) and
episodic nature (e.g., single, recurrent, etc.) of the disorder, the
fifth-digit assignment identifies severity of the episode: 0 Unspecified,
1 Mild, 2 Moderate, 3 Severe, without mention of psychotic behavior,
4 Severe, specified as with psychotic behavior, and 5 In partial or
unspecified remission. Subcategory 302.5 Trans-sexualism may be
assigned to report a patient’s sex reassignment surgery status, with the
appropriate fourth-digit subclassification to specify sexual history, if
known. For patients with gender identity disorder (302.85), an
additional code should be reported to identify sex reassignment surgery
status (302.5X), with the appropriate fourth-digit sexual history
designation. Codes in categories 303 Alcohol Dependence Syndrome,
304 Drug Dependence, and 305 Nondependent Use of Drugs are
reported using fifth-digit subclassifications that more specifically describe
the episode of abuse. These are: 0 Unspecified, 1 Continuous, 2
Episodic, and 3 In remission.
Terms To Know
diagnosis. Determination or confirmation of a condition, disease, or syndrome
and its implications.
evaluation and management. Assessment, counseling, and other services
provided to a patient reported through CPT codes.
insurance carrier. Insurer or health plan that may underwrite, administer,
or sell a range of health benefit programs.
noncovered procedure. Health care treatment not reimbursable according
to provisions of a given insurance policy, or in the case of Medicare, in
accordance with Medicare laws and regulations.
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
IOM References
100-1,3,30.1; 100-2,15,160; 100-2,15,170; 100-4,12,150;
100-4,12,160; 100-4,12,160.1; 100-4,12,170; 100-4,12,170.1;
100-4,12,210; 100-4,12,210.1
CCI Version 20.0
96150-96155
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
90887........................ 1.48
0.92
0.57
0.10
2.50
2.15
142
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
90889
90889
Preparation of report of patient's psychiatric status, history,
treatment, or progress (other than for legal or consultative
purposes) for other individuals, agencies, or insurance carriers
Explanation
The clinician prepares a report on a patient's mental condition, current
psychiatric status, history, treatment regimen, and progress for other
physicians, agencies, or insurance carriers involved with the patient’s
care, except for legal or consultative purposes.
Coding Tips
If this service is provided on the day the physician is provides other
services, an E/M code may be more appropriate. In the case of an
encounter where evaluation and psychotherapy were performed, the
appropriate psychotherapy code that includes the E/M service should
be used. The preparation of a report describing the patient’s psychiatric
condition and status provided to agencies, insurance carriers, and other
physicians (not including consultations) would be reported using 90889.
However, it is not to be used when providing information for legal
purposes. It should be noted that very few third-party payers provide
coverage of this service. In the case of reports provided at an agency's
or employer's request, a fee should be discussed and payment
arrangement made prior to the rendering of the service. Codes 291.0,
291.3, and 291.81 cover the various severity of symptoms associated
with alcohol withdrawal. ICD-9-CM has placed “Excludes” notes with
these subcategories to alert the coder that these three codes may not
be used in combination with each other. Also, the coder must use the
code that describes the highest level of symptom severity exhibited by
the patient. In other words, the hierarchy of severity is as follows: 291.0
Withdrawal with hallucinations, delirium, delirium tremens; 291.3
Withdrawal with hallucinosis; 291.81 Withdrawal. Idiosyncratic alcohol
intoxication (291.4) excludes acute alcohol intoxication, classified to
category 305 for patients not diagnosed as having alcoholism or
category 303 if associated with alcoholism. Schizophrenia is not
diagnosed unless there is characteristic disturbance of at least two of
these areas: thought, perception, mood, conduct, and personality. The
first axis of coding schizophrenia is to identify the type (e.g., simple,
disordered, paranoid, latent, residual, etc.). Identify the course of illness
with a fifth digit, as follows: 0 Unspecified, 1 Subchronic state:
continuous for more than six months but less than two years, 2 Chronic
state: continuous for more than two years, 3 Subchronic with acute
exacerbation: continuous for more than six months but less than two
years but psychotic features have resurfaced in patient who has been
in residual phase, 4 Chronic with acute exacerbation: continuous for
more than two years but psychotic features have resurfaced in patient
who has been in residual phase, and 5 In remission: history of
schizophrenia but free from symptoms, regardless of whether patient
is currently on medication. For category 296, while subcategories
identify the type (e.g., manic or major depressive, bipolar, etc.) and
episodic nature (e.g., single, recurrent, etc.) of the disorder, the
fifth-digit assignment identifies severity of the episode: 0 Unspecified,
1 Mild, 2 Moderate, 3 Severe, without mention of psychotic behavior,
4 Severe, specified as with psychotic behavior, and 5 In partial or
Work Value
90889........................ 0.00
© 2014 OptumInsight, Inc.
unspecified remission. Subcategory 302.5 Trans-sexualism may be
assigned to report a patient’s sex reassignment surgery status, with the
appropriate fourth-digit subclassification to specify sexual history, if
known. For patients with gender identity disorder (302.85), an
additional code should be reported to identify sex reassignment surgery
status (302.5x), with the appropriate fourth-digit sexual history
designation. Codes in categories 303 Alcohol Dependence Syndrome,
304 Drug Dependence, and 305 Nondependent Use of Drugs are
reported using fifth-digit subclassifications that more specifically describe
the episode of abuse. These are: 0 Unspecified, 1 Continuous, 2
Episodic, and 3 In remission.
Terms To Know
encounter. Direct personal contact between a patient and a physician, or
other person who is authorized by state licensure law and, if applicable, by
hospital staff bylaws, to order or furnish hospital services for diagnosis or
treatment of the patient.
evaluation and management. Assessment, counseling, and other services
provided to a patient reported through CPT codes.
noncovered procedure. Health care treatment not reimbursable according
to provisions of a given insurance policy, or in the case of Medicare, in
accordance with Medicare laws and regulations.
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
IOM References
100-1,3,30.1; 100-2,15,160; 100-2,15,170; 100-4,12,150;
100-4,12,160; 100-4,12,170; 100-4,12,170.1; 100-4,12,210;
100-4,12,210.1
CCI Version 20.0
96150-96155
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.00
0.00
0.00
0.00
0.00
CPT © 2014 American Medical Association. All Rights Reserved.
143
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
90901-90911
CCI Version 20.0
90901
Biofeedback training by any modality
90911
Biofeedback training, perineal muscles, anorectal or urethral
sphincter, including EMG and/or manometry
Explanation
Biofeedback trains patients to control their autonomic or involuntary
nervous system responses to regulate vital signs such as heart rate,
blood pressure, temperature, and muscle tension. Monitors of various
types are used to indicate body responses, which the patient learns to
associate with related stimuli and also control in serial sessions. This
code applies to any of several modalities of biofeedback training.
Biofeedback is used for treatment of conditions including high blood
pressure, incontinence, Raynaud's syndrome, and anticipatory nausea
due to chemotherapy. For biofeedback using any modality, see code
90901. When biofeedback is performed to help the incontinent patient
gain control of the related muscles, see code 90911.
12001-12007, 12011-12057, 13100-13133, 13151-13153, 36000,
36400-36410, 36420-36430, 36440, 36600, 36640, 37202, 43752,
51701-51703, 51784-51785, 62310-62319, 64400-64435,
64445-64450, 64479, 64483, 64490, 64493, 64505-64550,
90832-90834, 90836-90839, 90845-90853, 90865, 90880, 91122,
93000-93010, 93040-93042, 93318, 94002, 94200, 94250,
94680-94690, 94770, 95812-95816, 95819, 95822, 95829, 95955,
96360, 96365, 96372, 96374-96376, 99148-99149, 99150,
99211-99223, 99231-99255, 99291-99292, 99304-99310,
99315-99316, 99334-99337, 99347-99350, 99374-99375,
99377-99378, 99446-99449, 99495-99496, G0410-G0411
Also not with 90911: 51728-51729, 90901, 95860-95864,
95867-95872, 97032, 97110-97112, 97530, 97535, 97750
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Coding Tips
If biofeedback is used to facilitate psychotherapy, see codes 90875 and
90876. Medicare provides benefits for these procedures only when
medically necessary for the reeducation of specific muscle groups or
for the treatment of pathological muscle conditions not able to be
treated using conventional methods. Biofeedback is not covered for
muscle tension and for psychosomatic conditions. Be sure to check
coverage guidelines with each individual payer.
Terms To Know
autonomic nervous system. Portion of the nervous system that controls
involuntary body functions. The fibers of the autonomic nervous system regulate
the iris of the eye and the smooth-muscle action of the heart, blood vessels,
lungs, glands, stomach, colon, bladder, and other visceral organs that are not
under conscious control by the individual. The autonomic nerve fibers exit
from the central nervous system and branch out into the sympathetic and
parasympathetic nervous systems.
modality (therapeutic). Broad group of agents or any physical agent
applied to produce therapeutic/physiological changes to biologic tissue,
including thermal, acoustic, radiant (light), mechanical, or electric energy.
psychotherapy. Treatment for mental illness and behavioral disturbances
in which the clinician establishes a professional contract with the patient and,
through definitive therapeutic communication, attempts to alleviate the
emotional disturbances, reverse or change maladaptive patterns of behavior,
and encourage personality growth and development.
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
IOM References
100-2,16,10; 100-4,5,10.2; 100-5,5,40.7
Work Value
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
90901........................ 0.41
90911........................ 0.89
0.70
1.43
0.15
0.32
0.01
0.07
1.12
2.39
0.57
1.28
144
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
95970
95970
Electronic analysis of implanted neurostimulator pulse generator
system (eg, rate, pulse amplitude, pulse duration, configuration
of wave form, battery status, electrode selectability, output
modulation, cycling, impedance and patient compliance
measurements); simple or complex brain, spinal cord, or peripheral
(ie, cranial nerve, peripheral nerve, sacral nerve, neuromuscular)
neurostimulator pulse generator/transmitter, without
reprogramming
frequency. Number of times a given service is provided during a specified
time period.
noncovered procedure. Health care treatment not reimbursable according
to provisions of a given insurance policy, or in the case of Medicare, in
accordance with Medicare laws and regulations.
ICD-9-CM Diagnostic Codes
296.30
296.33
Explanation
A previously placed neurostimulator pulse generator is tested to verify
that it is functioning properly. The neurostimulator may be a simple or
complex brain, spinal cord, or peripheral device. Functions that may
be tested include rate, pulse amplitude, pulse duration, configuration
of waveform, battery status, electrode selectability, output modulation,
cycling, impedance, and patient compliance. This code reports testing
without reprogramming of the device.
296.34
Coding Tips
The vagus nerve, (tenth cranial nerve), originates in the medulla
oblongata, which is part of the brain stem. For patients with chronic
severe depression resistant to other treatments, stimulation of the brain
by electrical impulses transmitted via the vagus nerve, called vagus
nerve stimulation or VNS, can relieve the symptoms of depression.
Physicians can perform an electronic analysis to evaluate the implanted
device. This code is appropriate to use when the neurostimulator pulse
generator/transmitter is capable of affecting up to three of the following:
pulse amplitude, pulse duration, pulse frequency, eight or more
electrode contacts, cycling, stimulation train duration, train spacing,
number of programs, number of channels, alternating electrode
polarities, dose time (stimulation parameters changing in time periods
of minutes including dose lockout times), more than one clinical feature
(rigidity, dyskinesia, tremor, etc.). Although Medicare provides coverage
of VNS for the treatment of seizures when specific indication and
limitation requirements are met, benefits for VNS for resistant depression
is not covered. Check with your specific payers regarding benefits for
this service. For category 296—while subcategories identify the type
(e.g., manic or major depressive, bipolar, etc.) and episodic nature
(e.g., single, recurrent, etc.) of the disorder, the fifth-digit assignment
identifies severity of the episode: 0 Unspecified, 1 Mild, 2 Moderate, 3
Severe, without mention of psychotic behavior, 4 Severe, specified as
with psychotic behavior, and 5 In partial or unspecified remission.
301.11
301.12
Major depressive disorder, recurrent episode, unspecified
— (Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Major depressive disorder, recurrent episode, severe,
without mention of psychotic behavior — (Use additional
code to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Major depressive disorder, recurrent episode, severe,
specified as with psychotic behavior — (Use additional
code to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Chronic hypomanic personality disorder — (Use additional
code to identify any associated neurosis or psychosis, or
physical condition)
Chronic depressive personality disorder — (Use additional
code to identify any associated neurosis or psychosis, or
physical condition)
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
IOM References
100-4,32,50
CCI Version 20.0
0282T-0285T, 0317Tv, 95972v, 95974v
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Terms To Know
amplitude. Size, extent, abundance, fullness, or amount of movement.
depression. Disproportionate depressive state with behavior disturbance
that is usually the result of a distressing experience and may include
preoccupation with the psychic trauma and anxiety.
dyskinesia. Impairment of voluntary movement.
electrode. Electric terminal specialized for a particular electrochemical reaction
that acts as a medium between a body surface and another instrument,
commonly termed a lead.
Work Value
95970........................ 0.45
© 2014 OptumInsight, Inc.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
1.44
0.20
0.04
1.93
0.69
CPT © 2014 American Medical Association. All Rights Reserved.
145
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
95974-95975
95974
95975
ICD-9-CM Diagnostic Codes
296.30
Electronic analysis of implanted neurostimulator pulse generator
system (eg, rate, pulse amplitude, pulse duration, configuration
of wave form, battery status, electrode selectability, output
modulation, cycling, impedance and patient compliance
measurements); complex cranial nerve neurostimulator pulse
generator/transmitter, with intraoperative or subsequent
programming, with or without nerve interface testing, first hour
complex cranial nerve neurostimulator pulse
generator/transmitter, with intraoperative or subsequent
programming, each additional 30 minutes after first hour (List
separately in addition to code for primary procedure)
Explanation
A complex neurostimulator, a device that provides chronic electrical
stimulation to the nerves of the central or peripheral nervous system,
is implanted in the cranial nerve. The stimulation affects the pulse
(amplitude, duration, frequency) to treat, for example, the tremors
characteristic of Parkinson's disease. Report 95974 for the first hour of
electronic analysis of a complex cranial nerve neurostimulator pulse
generator/transmitter with intraoperative or subsequent programming,
including nerve interface testing if applicable. Report 95975 for each
additional 30 minutes.
Coding Tips
The vagus nerve (10th cranial nerve), originates in the medulla
oblongata, which is part of the brain stem. For patients with chronic
severe depression resistant to other treatments, stimulation of the brain
by electrical impulses transmitted via the vagus nerve, called vagus
nerve stimulation or VNS, can relieve the symptoms of depression.
Physicians can perform an electronic analysis to evaluate the implanted
device with or without programming. These codes are appropriate to
use when the neurostimulator pulse generator/transmitter is capable
of affecting four or more of the following: pulse amplitude, pulse
duration, pulse frequency, eight or more electrode contacts, cycling,
stimulation train duration, train spacing, number of programs, number
of channels, alternating electrode polarities, dose time (stimulation
parameters changing in time periods of minutes including dose lockout
times), or more than one clinical feature (rigidity, dyskinesia, tremor,
etc.). Although Medicare provides coverage of VNS for the treatment
of seizures when specific indication and limitation requirements are
met, benefits for VNS for resistant depression is not covered. Check
with the specific payer to determine coverage.
296.33
296.34
301.11
301.12
Major depressive disorder, recurrent episode, unspecified
— (Use additional code to identify any associated physical
disease, injury, or condition affecting the brain with
psychoses classifiable to 295-298)
Major depressive disorder, recurrent episode, severe,
without mention of psychotic behavior — (Use additional
code to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Major depressive disorder, recurrent episode, severe,
specified as with psychotic behavior — (Use additional
code to identify any associated physical disease, injury, or
condition affecting the brain with psychoses classifiable to
295-298)
Chronic hypomanic personality disorder — (Use additional
code to identify any associated neurosis or psychosis, or
physical condition)
Chronic depressive personality disorder — (Use additional
code to identify any associated neurosis or psychosis, or
physical condition)
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
Also not with 95974: 0317Tv
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Terms To Know
amplitude. Size, extent, abundance, fullness, or amount of movement.
dyskinesia. Impairment of voluntary movement.
electrode. Electric terminal specialized for a particular electrochemical reaction
that acts as a medium between a body surface and another instrument,
commonly termed a lead.
frequency. Number of times a given service is provided during a specified
time period.
Work Value
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
95974........................ 3.00
95975........................ 1.70
2.59
1.31
1.38
0.80
0.25
0.11
5.84
3.12
4.63
2.61
146
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
96020
96020
Neurofunctional testing selection and administration during
noninvasive imaging functional brain mapping, with test
administered entirely by a physician or other qualified health care
professional (ie, psychologist), with review of test results and report
Explanation
During a separately reported functional MRI (fMRI), the physician or
psychologist administers a series of tests involving language, memory,
cognition, movement, and sensation, and reviews the results and reports
upon them in a process called functional brain mapping. These reports
identify the expected versus observed locations of brain activity
documented by the fMRI as the patient performs specific tasks.
Coding Tips
Code 96020 should not be reported with psychological testing
(96101–96103) or neurobehavioral status examination services
(96116–96120). Evaluation and management services would not be
reported for the same date of service. When a functional MRI is
performed and the neurofunctional tests are provided by a technician
or other nonphysician, nonpsychologist provider, see 70554. See 70555
when neurofunctional testing is provided by the physician or
psychologist and his or her presence is required during the entire MRI.
Code 70555 should not be reported except when 96020 is performed.
Do not report 96020 with 70554. Neurofunctional testing should not
be reported in addition to psychological testing (96101-96103) or
neurobehavioral status examinations or testing (96116-96120).
Terms To Know
evaluation and management. Assessment, counseling, and other services
provided to a patient reported through CPT codes.
fMRI. Functional magnetic resonance imaging. Technique to identify which
part of the brain is activated by stimulus or activity; a type of brain mapping
useful prior to brain surgery and in cases of epilepsy and mental disorders. fMRI
is reported with CPT codes 70554 and 70555.
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
CCI Version 20.0
0199T, 0333T, 92558, 92585-92588, 95812-95816, 95819, 95829,
95831-95834, 95851-95852, 95860-95870, 95907-95913,
95925-95930, 95938-95940, 96101-96103, 96116, 96118-96125,
99446-99449, G0453
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Work Value
96020........................ 0.00
© 2014 OptumInsight, Inc.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.00
0.00
0.00
0.00
0.00
CPT © 2014 American Medical Association. All Rights Reserved.
147
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
96101-96103
96101
96102
96103
ICD-9-CM Diagnostic Codes
Psychological testing (includes psychodiagnostic assessment of
emotionality, intellectual abilities, personality and
psychopathology, eg, MMPI, Rorschach, WAIS), per hour of the
psychologist's or physician's time, both face-to-face time
administering tests to the patient and time interpreting these test
results and preparing the report
Psychological testing (includes psychodiagnostic assessment of
emotionality, intellectual abilities, personality and
psychopathology, eg, MMPI and WAIS), with qualified health care
professional interpretation and report, administered by technician,
per hour of technician time, face-to-face
Psychological testing (includes psychodiagnostic assessment of
emotionality, intellectual abilities, personality and
psychopathology, eg, MMPI), administered by a computer, with
qualified health care professional interpretation and report
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
IOM References
100-1,3,30; 100-1,3,30.3; 100-2,15,80.2; 100-2,15,160; 100-4,12,210;
100-4,12,210.1
CCI Version 20.0
96110v, 96125, G0451v
Also not with 96101: 96102-96103v
Also not with 96102: 96103v
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Explanation
The physician or psychologist administers and interprets the results of
psychological testing. The testing in written, oral, computer, or
combined formats measures personality, emotions, intellectual
functioning, and psychopathology. Code 96101 applies to each hour
of testing and includes both face-to-face time administering tests to
the patient, as well as interpretation and preparation of the report;
however, it is not used to report the interpretation of technician- or
computer-administered tests. In 96102, a technician administers the
test, which is interpreted and reported by a qualified health care
professional. In 96103, the test is administered by computer, which is
interpreted and reported by a qualified health care professional.
Coding Tips
These codes are used to report services provided during testing of the
cognitive function of the central nervous system. Report these codes
once for each hour of testing, which includes interpretation and
preparation of the report. A written report must be generated. A
minimum of 31 minutes must be provided before assigning one of
these codes. Codes 96102 and 96103 are used when the testing is
preformed by a qualified technician or computer, respectively. It is
appropriate, however, to assign code 96101 when reporting the
additional time necessary for the health care provider to incorporate
clinical data including data previously completed and reported by a
technician- or computer-administered testing data.
Terms To Know
assessment. Process of collecting and studying information and data, such
as test values, signs, and symptoms.
cognitive. Being aware by drawing from knowledge, such as judgment,
reason, perception, and memory.
interpretation. Professional health care provider's review of data with a written
or verbal opinion.
Work Value
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
96101........................ 1.86
96102........................ 0.50
96103........................ 0.51
0.33
1.32
0.24
0.31
0.13
0.21
0.07
0.03
0.03
2.26
1.85
0.78
2.24
0.66
0.75
148
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
96110-96111
CCI Version 20.0
96110
Developmental screening, with interpretation and report, per
standardized instrument form
96111
Developmental testing, (includes assessment of motor, language,
social, adaptive, and/or cognitive functioning by standardized
developmental instruments) with interpretation and report
Also not with 96111: 90791-90792, 90832-90834, 90836-90839,
90845-90853, 90865, 90870, 90880, 92002-92014, 96101-96103v,
96110, 96118-96125, 97001-97004, 99201-99239, 99281-99285,
99291, 99304-99310, 99315-99318, 99324-99328, 99334-99337,
99341-99350, 99466-99480, 99485, G0380-G0384, G0406-G0408,
G0410-G0411, G0425-G0427, G0451, G0459
Explanation
The physician or other health care professional performs a
developmental screening on a provider standardized form (meeting
industry standards). The screening is to determine whether the patient
needs additional work up for a developmental disorder or at periodic
intervals throughout infancy and adolescent years. This code includes
interpretation and report of the findings.
Also not with 96110: 96125
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Coding Tips
Note that these codes are not time-based codes. Information obtained
through the assessment testing is interpreted and a written report is
generated. The interpretation and preparation of the report are included
in the service. Developmental screening includes screening for
conditions such as autism and behavioral and emotional disorders.
Developmental testing includes the assessment of motor, language,
social, adaptive, and/or cognitive function. For neuropsychological
testing, see codes from range 96118–96120. For psychological testing,
see codes from range 96101–96103.
Terms To Know
cognitive. Being aware by drawing from knowledge, such as judgment,
reason, perception, and memory.
motor function. Ability to learn or demonstrate skillful and efficient
assumption, maintenance, modification, and control of voluntary postures and
movement patterns.
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
IOM References
100-1,3,30; 100-1,3,30.1; 100-1,3,30.3; 100-2,15,80.2;
100-2,15,230.4; 100-4,5,10.2; 100-4,12,150; 100-4,12,160;
100-4,12,170; 100-4,12,170.1
Work Value
96110........................ 0.00
96111........................ 2.60
© 2014 OptumInsight, Inc.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.22
0.88
0.22
0.68
0.01
0.15
0.23
3.63
0.23
3.43
CPT © 2014 American Medical Association. All Rights Reserved.
149
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
96116
96116
Neurobehavioral status exam (clinical assessment of thinking,
reasoning and judgment, eg, acquired knowledge, attention,
language, memory, planning and problem solving, and visual
spatial abilities), per hour of the psychologist's or physician's time,
both face-to-face time with the patient and time interpreting test
results and preparing the report
Explanation
The physician or psychologist evaluates aspects of thinking, reasoning,
and judgment to evaluate a patient's neurocognitive abilities. This code
applies to each hour of examination time and includes both face-to-face
time with the patient and time spent interpreting test results and
preparing a report.
Coding Tips
Report this code once for each hour of testing, which includes
interpretation and preparation of the report. A written report must be
generated. A minimum of 31 minutes of testing must be provided
before assigning one of these codes. For psychological testing, see
codes from range 96101–96103. For neuropsychological testing, see
codes from range 96118–96120. Developmental screening or testing
is reported using 96110 or 96111, respectively.
Terms To Know
assessment. Process of collecting and studying information and data, such
as test values, signs, and symptoms.
cognitive. Being aware by drawing from knowledge, such as judgment,
reason, perception, and memory.
interpretation. Professional health care provider's review of data with a written
or verbal opinion.
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
IOM References
100-1,3,30; 100-1,3,30.3; 100-2,15,80.2; 100-2,15,270;
100-2,15,270.2; 100-2,15,270.4; 100-4,12,190.3; 100-4,12,190.7
CCI Version 20.0
96105-96111, 96125, G0451
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Work Value
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
96116........................ 1.86
0.69
0.52
0.10
2.65
2.48
150
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
96118-96120
96118
IOM References
Neuropsychological testing (eg, Halstead-Reitan
Neuropsychological Battery, Wechsler Memory Scales and
Wisconsin Card Sorting Test), per hour of the psychologist's or
physician's time, both face-to-face time administering tests to the
patient and time interpreting these test results and preparing the
report
96119
Neuropsychological testing (eg, Halstead-Reitan
Neuropsychological Battery, Wechsler Memory Scales and
Wisconsin Card Sorting Test), with qualified health care
professional interpretation and report, administered by technician,
per hour of technician time, face-to-face
96120
Neuropsychological testing (eg, Wisconsin Card Sorting Test),
administered by a computer, with qualified health care professional
interpretation and report
100-1,3,30; 100-1,3,30.3; 100-2,15,80.2
CCI Version 20.0
96110v, G0451v
Also not with 96118: 96119-96125
Also not with 96119: 96120-96125
Also not with 96120: 96125
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Explanation
The physician or psychologist administers a series of tests in thinking,
reasoning, judgment, and memory to evaluate the patient's
neurocognitive abilities. Code 96118 applies to each hour of testing
and includes face-to-face time administering tests to the patient, as
well as interpretation and preparation of the report; however, it is not
used to report the interpretation of technician- or
computer-administered tests. In 96119, a technician administers the
test, which is interpreted and reported by a qualified health care
professional. In 96120, the test is administered by computer, which is
interpreted and reported by a qualified health care professional.
Coding Tips
Codes 96118 and 96119 are reported per hour of service. Information
obtained through the assessment testing is interpreted and a written
report is generated. The interpretation and preparation of the report
are included in the service. For psychological testing, see codes from
range 96101–96103; for neurobehavioral testing, see code 96116; for
standardized cognitive performance testing, see code 96125; for
developmental screening or testing, see codes from range
96110–96111. Code 96118 is not to be reported for the interpretation
and reporting or either 96119 or 96120. Code 96118 may also be
reported when additional time is needed to integrate other clinical data
including technician and computer-administered test results.
Terms To Know
assessment. Process of collecting and studying information and data, such
as test values, signs, and symptoms.
cognitive. Being aware by drawing from knowledge, such as judgment,
reason, perception, and memory.
interpretation. Professional health care provider's review of data with a written
or verbal opinion.
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
Work Value
96118........................ 1.86
96119........................ 0.55
96120........................ 0.51
© 2014 OptumInsight, Inc.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.84
1.71
0.80
0.30
0.10
0.19
0.07
0.01
0.03
2.77
2.27
1.34
2.23
0.66
0.73
CPT © 2014 American Medical Association. All Rights Reserved.
151
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
96125
96125
Standardized cognitive performance testing (eg, Ross Information
Processing Assessment) per hour of a qualified health care
professional's time, both face-to-face time administering tests to
the patient and time interpreting these test results and preparing
the report
Explanation
A qualified health care professional administers standardized cognitive
performance testing to evaluate such factors as the patient's immediate,
recent, and remote memory; temporal and spatial orientation; general
information recall; problem-solving and abstract reasoning abilities;
organizational skills; and auditory processing and retention. This code
applies to each hour of testing and includes face-to-face time
administering tests to the patient, as well as interpretation and
preparation of the report.
Coding Tips
Report this code once for each hour of testing, which includes
interpretation and preparation of the report. A written report must be
generated. A minimum of 31 minutes of testing must be provided
before assigning this code. For psychological testing, see codes from
range 96101–96103; for neurobehavioral testing, see code 96116; for
neuropsychological testing, see codes 96118–96120; for developmental
screening or testing, see codes from range 96110–96111.
Terms To Know
cognitive. Being aware by drawing from knowledge, such as judgment,
reason, perception, and memory.
interpretation. Professional health care provider's review of data with a written
or verbal opinion.
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
IOM References
100-2,15,80.2; 100-2,15,160; 100-2,15,230.4; 100-4,5,10.2;
100-4,5,10.6
CCI Version 20.0
No CCI Edits apply to this code.
Work Value
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
96125........................ 1.70
1.43
1.43
0.07
3.20
3.20
152
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
96150-96151
96150
96151
IOM References
Health and behavior assessment (eg, health-focused clinical
interview, behavioral observations, psychophysiological
monitoring, health-oriented questionnaires), each 15 minutes
face-to-face with the patient; initial assessment
re-assessment
100-1,3,30; 100-1,3,30.3; 100-2,15,270; 100-2,15,270.2;
100-2,15,270.4; 100-4,12,190.3; 100-4,12,190.7
CCI Version 20.0
96101-96111, 96116, 96118-96125, 99406-99407, G0396-G0397,
G0436-G0437, G0442-G0447, G0451
Also not with 96150: 96151-96154v
Explanation
These codes report assessment of psychological, behavioral, emotional,
cognitive, and relevant social factors that can prevent, treat, or manage
physical health problems. The assessment must be associated with an
acute or chronic illness, the prevention of a physical illness or disability,
and the maintenance of health. The initial assessment (96150) and
re-assessment (96151) apply to each 15-minute direct, face-to-face
session with the patient. A reassessment (96151) is reported to obtain
objective measures of goals formulated in the initial assessment and to
modify plans as is indicated to support the goals.
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Coding Tips
These services are used to identify the assessment of a patient’s
psychological, behavioral, emotional, cognitive, and social factors as
they relate to the prevention, treatment, or management of conditions
affecting the patient’s physical health. These codes do not identify a
service that focuses on the mental health of the patient, but rather on
the biopsychosocial factors that are, or could affect the treatment of
or severity of, the patient’s physical condition. These services are,
however, used to modify the psychological, behavioral, emotional,
cognitive, and social factors that are identified directly affecting the
patient’s physiological functioning, disease status, health, and general
well-being. They are offered to those patients that have established
illnesses or symptoms, but who are not diagnosed with mental illness.
They do not, however, represent preventive medical counseling or risk
factor reduction interventions. For patients that require psychiatric
services as well as health and behavior assessment/intervention, report
those services using the appropriate code from the 90785–90899 or
96150–96155 range, respectively. However, do not report codes
90785–90899 and 96150–96155 on the same date of service. Report
codes 96150 or 96151 for a health and behavior assessment;
96152–96155 for interventional services.
Terms To Know
assessment. Process of collecting and studying information and data, such
as test values, signs, and symptoms.
cognitive. Being aware by drawing from knowledge, such as judgment,
reason, perception, and memory.
intervention. Purposeful interaction of the physical therapist with the patient
and, when appropriate, with other individuals involved in patient care, using
various physical therapy procedures and techniques to produce changes in the
condition.
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
Work Value
96150........................ 0.50
96151........................ 0.48
© 2014 OptumInsight, Inc.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.09
0.09
0.08
0.08
0.01
0.01
0.60
0.58
0.59
0.57
CPT © 2014 American Medical Association. All Rights Reserved.
153
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
96152-96155
96152
ICD-9-CM Diagnostic Codes
Health and behavior intervention, each 15 minutes, face-to-face;
individual
96153
group (2 or more patients)
96154
family (with the patient present)
96155
family (without the patient present)
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
IOM References
100-1,3,30; 100-1,3,30.3
CCI Version 20.0
Also not with 96152: 96151v, 99406-99407, G0396-G0397,
G0436-G0437, G0442-G0447
Explanation
These are interventional services prescribed to modify the psychological,
behavioral, emotional, cognitive, and social factors relevant to and
affecting the patient's physical health problems. Each code applies to
a 15-minute session of direct face-to-face intervention. Report 96152
for the initial assessment with the individual/patient only. Report 96153
for intervention attended by a group (two or more patients). Report
96154 for intervention that includes the family with the patient present.
Report 96155 for intervention with the family without the patient’s
presence.
Also not with 96153: 96151-96152v, 96154v, 99406-99407,
G0396-G0397, G0436-G0437, G0442-G0447
Also not with 96154: 96151-96152v, 99406-99407, G0396-G0397,
G0436-G0437, G0442-G0447
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Coding Tips
These services are used to identify the assessment of a patient’s
psychological, behavioral, emotional, cognitive, and social factors as
they relate to the prevention, treatment, or management of conditions
affecting the patient’s physical health. These codes do not identify a
service that focuses on the mental health of the patient but rather on
the biopsychosocial factors that are, or could affect the treatment of
or severity of, the patient’s physical condition. These services are,
however, used to modify the psychological, behavioral, emotional,
cognitive, and social factors that are identified directly affecting the
patient’s physiological functioning, disease status, health, and general
well-being. They are offered to those patients that have established
illnesses or symptoms, but who are not diagnosed with mental illness.
They do not, however, represent preventive medical counseling or risk
factor reduction interventions. For patients that require psychiatric
services as well as health and behavior assessment/intervention, report
those services using the appropriate code from the 90785–90899 or
96150–96155 range respectively. However, do not report codes
90785–90899 and 96150–96155 on the same date of service. Report
codes 96150 or 96151 for a health and behavior assessment;
96152–96155 for interventional services.
Terms To Know
assessment. Process of collecting and studying information and data, such
as test values, signs, and symptoms.
cognitive. Being aware by drawing from knowledge, such as judgment,
reason, perception, and memory.
intervention. Purposeful interaction of the physical therapist with the patient
and, when appropriate, with other individuals involved in patient care, using
various physical therapy procedures and techniques to produce changes in the
condition.
Work Value
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
96152........................ 0.46
96153........................ 0.10
96154........................ 0.45
96155........................ 0.44
0.08
0.02
0.08
0.17
0.07
0.02
0.07
0.17
0.01
0.01
0.01
0.03
0.55
0.13
0.54
0.64
0.54
0.13
0.53
0.64
154
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
97532
97532
326
Development of cognitive skills to improve attention, memory,
problem solving (includes compensatory training), direct
(one-on-one) patient contact, each 15 minutes
Explanation
A patient with inherited learning disabilities or in individuals who have
lost these skills as a result of illness or brain injury is worked with on a
direct, one-on-one basis to assist in the development of cognitive skills.
The individual often needs to develop compensatory methods of
processing and retrieving information when disability, illness, or injury
has affected these cognitive processes. Cognitive skill development
includes mental exercises that assist the patient in areas such as
attention, memory, perception, language, reasoning, planning,
problem-solving, and related skills.
Coding Tips
This procedure may be performed by a physician or other qualified
health care professional. Check with the specific payer to determine
coverage. The following is a sample of a clinical vignette for this code.
A 74-year-old male presents with a combination of depression and
organic brain syndrome. The patient lives with his wife but has difficulty
remembering to take his medications and, according to his wife,
remembering to eat. The clinician develops a structured system by
which the patient incorporates taking his medication and eating meals
at a set time each day as part of his daily living activities after a thorough
discussion of the home environment and the couple's daily routine.
332.1
333.4
334.0
334.2
334.3
334.4
430
431
432.0
432.1
432.9
436
438.0
Terms To Know
438.10
cognitive. Being aware by drawing from knowledge, such as judgment,
reason, perception, and memory.
depression. Disproportionate depressive state with behavior disturbance
that is usually the result of a distressing experience and may include
preoccupation with the psychic trauma and anxiety.
438.11
ICD-9-CM Diagnostic Codes
294.10
294.11
294.8
294.9
Dementia in conditions classified elsewhere without
behavioral disturbance — (Code first any underlying
physical condition: 046.11-046.19, 094.1, 275.1, 330.1,
331.0, 331.11, 331.19, 331.82, 333.4, 340, 345.0-345.9,
446.0)
Dementia in conditions classified elsewhere with behavioral
disturbance — (Code first any underlying physical
condition: 046.11-046.19, 094.1, 275.1, 330.1, 331.0,
331.11, 331.19, 331.82, 332.0, 333.4, 340, 345.0-345.9,
446.0)(Use additional code, where applicable, to identify:
V40.31)
Other persistent mental disorders due to conditions
classified elsewhere — (Use additional code for associated
epilepsy: 345.0-345.9)
Unspecified persistent mental disorders due to conditions
classified elsewhere
Work Value
97532........................ 0.44
© 2014 OptumInsight, Inc.
V40.0
V40.1
Late effects of intracranial abscess or pyogenic infection —
(Use additional code to identify condition: 331.4,
342.0-342.9, 344.0-344.9)
Secondary Parkinsonism — (Use additional E code to
identify drug, if drug-induced)
Huntington's chorea
Friedreich's ataxia
Primary cerebellar degeneration
Other cerebellar ataxia — (Use additional E code to identify
drug, if drug-induced)
Cerebellar ataxia in diseases classified elsewhere — (Code
first underlying disease: 140.0-239.9, 244.0-244.9,
303.0-303.9)
Subarachnoid hemorrhage — (Use additional code to
identify presence of hypertension)
Intracerebral hemorrhage — (Use additional code to
identify presence of hypertension)
Nontraumatic extradural hemorrhage — (Use additional
code to identify presence of hypertension)
Subdural hemorrhage — (Use additional code to identify
presence of hypertension)
Unspecified intracranial hemorrhage — (Use additional
code to identify presence of hypertension)
Acute, but ill-defined, cerebrovascular disease — (Use
additional code to identify presence of hypertension)
Cognitive deficits due to cerebrovascular disease — (Use
additional code to identify presence of hypertension)
Unspecified speech and language deficit due to
cerebrovascular disease — (Use additional code to identify
presence of hypertension)
Aphasia due to cerebrovascular disease — (Use additional
code to identify presence of hypertension)
Problems with learning
Problems with communication (including speech)
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
IOM References
100-2,15,230; 100-2,15,230.1; 100-2,15,230.2; 100-2,15,230.4;
100-4,5,10
CCI Version 20.0
0213T, 0216T, 0228T-0231T, 62310-62319, 64400-64435,
64445-64450, 64479-64490, 64493, 64505-64530, 97002, 97004
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.30
0.30
0.01
0.75
0.75
CPT © 2014 American Medical Association. All Rights Reserved.
155
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
97533
97533
333.4
333.5
Sensory integrative techniques to enhance sensory processing and
promote adaptive responses to environmental demands, direct
(one-on-one) patient contact, each 15 minutes
Explanation
Individuals with sensory integration disorders are worked with to teach
techniques for enhancing sensory processing and adapting to
environmental demands. Sensory experiences include touch, movement,
body awareness, sight, sound, and the pull of gravity. The process of
the brain organizing and interpreting this information is called sensory
integration. Sensory integration provides a crucial foundation for later,
more complex learning and behavior. Sensory integration disorders
may be the result of a learning disability, illness, or brain injury.
Coding Tips
334.0
334.2
334.3
334.4
348.1
430
431
This procedure may be performed by a physician or other qualified
health care professional. Check with the specific payer to determine
coverage. The following is a sample clinical vignette for sensory
integrative techniques used for this code. A child is fearful of walking
down stairs, has poor balance, and difficulty focusing on the task.
Evaluation revealed the patient to exhibit difficulty in processing
vestibular, proprioceptive, and tactile input. The child is engaged in
activities that provide the appropriate sensory input including heavy
touch or pressure with graded movement in order to improve the
patient’s ability to make adaptive motor and behavioral responses. This
also helps the child cope with environmental demands. With the
improvement in sensorimotor and perceptual skills, the patient is able
to walk down stairs with less fear and better balance. The child also
appears to be able to sit longer to attend to an assigned task.
432.0
Terms To Know
V40.0
V40.1
sensory integration. Ability to integrate information that is derived from
the environment and that relates to movement.
tactile. Having or related to touch.
ICD-9-CM Diagnostic Codes
294.8
294.9
330.8
330.9
331.89
332.1
Other persistent mental disorders due to conditions
classified elsewhere — (Use additional code for associated
epilepsy: 345.0-345.9)
Unspecified persistent mental disorders due to conditions
classified elsewhere
Other specified cerebral degenerations in childhood —
(Use additional code to identify associated intellectual
disabilities)
Unspecified cerebral degeneration in childhood — (Use
additional code to identify associated intellectual
disabilities)
Other cerebral degeneration — (Use additional code, where
applicable, to identify dementia: 294.10, 294.11)
Secondary Parkinsonism — (Use additional E code to
identify drug, if drug-induced)
Work Value
432.1
432.9
436
438.0
438.10
Huntington's chorea
Other choreas — (Use additional E code to identify drug,
if drug-induced)
Friedreich's ataxia
Primary cerebellar degeneration
Other cerebellar ataxia — (Use additional E code to identify
drug, if drug-induced)
Cerebellar ataxia in diseases classified elsewhere — (Code
first underlying disease: 140.0-239.9, 244.0-244.9,
303.0-303.9)
Anoxic brain damage — (Use additional E code to identify
cause)
Subarachnoid hemorrhage — (Use additional code to
identify presence of hypertension)
Intracerebral hemorrhage — (Use additional code to
identify presence of hypertension)
Nontraumatic extradural hemorrhage — (Use additional
code to identify presence of hypertension)
Subdural hemorrhage — (Use additional code to identify
presence of hypertension)
Unspecified intracranial hemorrhage — (Use additional
code to identify presence of hypertension)
Acute, but ill-defined, cerebrovascular disease — (Use
additional code to identify presence of hypertension)
Cognitive deficits due to cerebrovascular disease — (Use
additional code to identify presence of hypertension)
Unspecified speech and language deficit due to
cerebrovascular disease — (Use additional code to identify
presence of hypertension)
Problems with learning
Problems with communication (including speech)
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
IOM References
100-2,15,230; 100-2,15,230.1; 100-2,15,230.2; 100-2,15,230.4;
100-4,5,10
CCI Version 20.0
0213T, 0216T, 0228T-0231T, 62310-62319, 64400-64435,
64445-64450, 64479-64490, 64493, 64505-64530, 97002, 97004
Note: These CCI edits are used for Medicare. Other payers may
reimburse on codes listed above.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
97533........................ 0.44
0.37
0.37
0.01
0.82
0.82
156
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Coding and Payment Guide for Behavioral Health Services
Procedure Codes
98960-98962
98960
Education and training for patient self-management by a qualified,
nonphysician health care professional using a standardized
curriculum, face-to-face with the patient (could include
caregiver/family) each 30 minutes; individual patient
98961
2-4 patients
98962
5-8 patients
Explanation
The qualified, nonphysician health care professional provides education
and training using a standard curriculum. This training is prescribed by
a physician to enable the patient to concurrently self-manage
established illnesses or diseases with health care providers. Report 98960
for education and training provided for an individual patient for each
30 minutes of service. Report 98961 for a group of two to four patients
and 98962 for a group of five to eight patients.
Coding Tips
The focus of the training should be to teach patients how to effectively
manage their clinical condition. The training may also include a patient’s
caregiver. The service can be provided to either a single patient (98960)
or a group of patients (98961–98962). For individual counseling and
education provided by a physician, see the evaluation and management
codes; for group education and counseling, see code 99078. See
96150–96155 when a health and behavior assessment or intervention
is provided that is not part of a standard curriculum.
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
IOM References
100-2,15,230.4
CCI Version 20.0
No CCI Edits apply to this code.
Work Value
98960........................ 0.00
98961........................ 0.00
98962........................ 0.00
© 2014 OptumInsight, Inc.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.76
0.36
0.26
0.76
0.36
0.26
0.01
0.01
0.01
0.77
0.37
0.27
0.77
0.37
0.27
CPT © 2014 American Medical Association. All Rights Reserved.
157
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
98966-98968
98966
IOM References
Telephone assessment and management service provided by a
qualified nonphysician health care professional to an established
patient, parent, or guardian not originating from a related
assessment and management service provided within the previous
7 days nor leading to an assessment and management service or
procedure within the next 24 hours or soonest available
appointment; 5-10 minutes of medical discussion
98967
11-20 minutes of medical discussion
98968
21-30 minutes of medical discussion
100-2,15,230.4; 100-4,12,30.6.16
CCI Version 20.0
No CCI Edits apply to this code.
Explanation
A qualified health care professional (nonphysician) provides telephone
assessment and management services to a patient in a non-face-to-face
encounter. These episodes of care may be initiated by an established
patient or by the patient's guardian. These codes are not reported if
the telephone service results in a decision to see the patient within 24
hours or at the next available urgent visit appointment; instead, the
phone encounter is regarded as part of the pre-service work of the
subsequent face-to-face encounter. These codes are also not reported
if the telephone call is in reference to a service performed and reported
by the qualified health care professional that occurred within the past
seven days or within the postoperative period of a previously completed
procedure. This applies both to unsolicited patient follow-up or that
requested by the health care professional. Report 98966 for telephone
services requiring five to 10 minutes of medical discussion, 98967 for
telephone services requiring 11 to 20 minutes of medical discussion,
and 98968 for telephone services requiring 21 to 30 minutes of medical
discussion. Do not report 98966-98968 if these codes have been
reported within the previous seven days.
Coding Tips
Telephone services report the evaluation and management provided
by the nonphysician provider to an established patient or the guardian
of the established patient and must be initiated by the patient. These
codes are only reported if there is no decision to see the patient within
24 hours or the next available urgent appointment, or if it does not
refer to an E/M service performed and reported by the physician within
seven days or within the postoperative period of the previously
completed procedure. Appropriate code selection is dependent upon
the time spent in discussion with the patient. Time documenting the
discussion is excluded. This procedure may be performed by a physician
or other qualified health care professional. Check with the specific payer
to determine coverage.
Terms To Know
evaluation and management. Assessment, counseling, and other services
provided to a patient reported through CPT codes.
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
Work Value
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
98966........................ 0.25
98967........................ 0.50
98968........................ 0.75
0.13
0.23
0.33
0.10
0.19
0.29
0.01
0.03
0.05
0.39
0.76
1.13
0.36
0.72
1.09
158
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.
Coding and Payment Guide for Behavioral Health Services
Procedure Codes
98969
98969
Online assessment and management service provided by a
qualified nonphysician health care professional to an established
patient or guardian, not originating from a related assessment
and management service provided within the previous 7 days,
using the Internet or similar electronic communications network
Explanation
On-line medical assessment and management services are provided to
an established patient or guardian in response to a patient's on-line
inquiry utilizing Internet resources in a non-face-to-face encounter.
Services must be provided by a qualified health care professional
(nonphysician). In order for these services to be reportable, the health
care professional must provide a personal, timely response to the inquiry
and the encounter must be permanently stored via electronic means
or hard copy. A reportable service includes all communication related
to the on-line encounter, such as phone calls, provision of prescriptions,
and orders for laboratory services. This code is not reported if the on-line
evaluation is in reference to a service performed and reported by the
same health care professional within the past seven days or within the
postoperative period of a previously completed procedure. Rather, the
on-line service is considered to be part of the previous service or
procedure. This applies both to unsolicited patient follow-up or that
requested by the health care professional. Report 98969 only once for
the same episode of care during a seven-day period.
Coding Tips
This procedure may be performed by a physician or other qualified
health care professional. Check with the specific payer to determine
coverage. This code is not reported if the online evaluation is in
reference to a service performed and reported by the same health care
professional within the past seven days or within the postoperative
period of a previously completed procedure. Rather, the online service
is considered to be part of the previous service or procedure. This applies
both to unsolicited patient follow-up or that requested by the health
care professional. Report 98969 only once for the same episode of care
during a seven-day period. Do not report online assessment and
management services during the same month that complex chronic
care coordination (99487-99489) or transitional care management
services (99495-99496) are reported.
ICD-9-CM Diagnostic Codes
The application of this code is too broad to adequately present
ICD-9-CM diagnostic code links here. Refer to your ICD-9-CM book.
IOM References
100-2,15,230.4
CCI Version 20.0
No CCI Edits apply to this code.
Work Value
98969........................ 0.00
© 2014 OptumInsight, Inc.
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
0.00
0.00
0.00
0.00
0.00
CPT © 2014 American Medical Association. All Rights Reserved.
159
Procedure Codes
Coding and Payment Guide for Behavioral Health Services
99510
99510
Home visit for individual, family, or marriage counseling
Explanation
A nonphysician home health professional makes an initial visit to the
home to evaluate specific needs. If home health care would be of
benefit, a plan of care is developed based on medical orders from the
patient's provider. For example, a plan might specify one or more visits
from a therapist. The provider regularly reviews progress reports.
Coding Tips
This code is for use by the nonphysician provider. For physician services,
see the evaluation and management home visits (99341–99350),
individual psychotherapy (90804–90815), family psychotherapy
(90846–90847), and group psychotherapy (90853) codes. Those
nonphysician providers who may report E/M codes may report an E/M
service with this code when the E/M service is significant and separately
identifiable. Medical record documentation must support the use of
both codes.
Terms To Know
counseling. Discussion with a patient and/or family concerning one or more
of the following areas: diagnostic results, impressions, and/or recommended
diagnostic studies; prognosis; risks and benefits of management (treatment)
options; instructions for management (treatment) and/or follow-up; importance
of compliance with chosen management (treatment) options; risk factor
reduction; and patient and family education.
ICD-9-CM Diagnostic Codes
V62.81
V62.82
V62.89
V62.9
V65.40
V65.42
V65.44
V65.45
V65.49
Interpersonal problem, not elsewhere classified
Bereavement, uncomplicated
Other psychological or physical stress, not elsewhere
classified
Unspecified psychosocial circumstance
Counseling NOS
Counseling on substance use and abuse
Human immunodeficiency virus (HIV) counseling
Counseling on other sexually transmitted diseases
Other specified counseling
Please note that this list of associated ICD-9-CM codes is not
all-inclusive. The procedure may be performed for reasons other than
those listed that support the medical necessity of the service. Only
those conditions supported by the medical record documentation
should be reported.
CCI Version 20.0
No CCI Edits apply to this code.
Work Value
Non-Fac PE
Fac PE
Malpractice
Non-Fac Total
Fac Total
99510........................ 0.00
0.00
0.00
0.00
0.00
0.00
160
CPT © 2014 American Medical Association. All Rights Reserved.
© 2014 OptumInsight, Inc.