How to use CPT code 90785 for interactive complexity
90785 is an add-on code used to reflect communication difficulties during a psychiatric procedure, such as a psychotherapy session.
CPT code 99202 represents a new patient appointment that’s at least 15 minutes in duration.
The 99202 code is an E/M code used by prescribing providers.
Code 99202 represents a new patient appointment that’s at least 15 minutes in duration. It’s a prescriber code, which means it’s most commonly used by psychiatrists or nurse practitioners.
This is is how the American Medical Association defines 99202 in the official CPT codebook:
CPT code 99202: New patient office visit, minimum 15 minutes
Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
As a prescriber, you can bill insurance according to time or medical decision-making (MDM). Make sure to include sufficient documentation to support the method you choose.
If you spent 15 minutes with a client but the case was especially complex or high risk, or involved reviewing or analyzing a lot of data, you may use a higher CPT code, including 99203 (low MDM), 99204 (moderate MDM), or 99205 (high MDM).
It’s important to use the code that most accurately reflects the time you spent with the patient to treat their condition, and ensure that documentation for the session supports the chosen code.
If you’re treating an existing patient, you should use 99212 instead. A new patient is someone you have not seen in the last three years.
CPT code 99202 is a new patient appointment of at least 15 minutes. Other time frames for a new patient should be coded with [99203] (at least 30 minutes), [99204] (at least 45 minutes), or [99205] (at least 60 minutes).
If you’re treating an existing patient, you should use 99212 instead. A new patient is someone you have not seen in the last three years.
Documentation for 99202 is essentially the same as other E/M codes, but geared toward a new patient. New patient notes should always include:
Here’s a new patient example note:
Patient Name: Jane Smith
Date of Service: 03/16/2022
Patient DOB: 6/13/1990
Appointment Time: 11:30am-12:00pm
Place of Service: Patient was located at their home at 123 Main St Anywhere US 12345
Provider was located at their office: 456 Storybook Ln Hollywood CA 96852
This session was provided via a HIPAA compliant interactive audio/video platform. The patient consented to this telemedicine encounter.
The total time I spent caring for this patient today was 28 minutes which included: interviewing the client, documenting, reviewing the patient's responses to questionnaires, discussing treatment plans, coordinating care, prescription management and counseling the client on managing her mental health.
Chief Complaint: Patient presents with a complaint of mild anxiety and occasional trouble sleeping.
HPI: 32-year-old female reports feeling mildly anxious over the past two months, mainly due to work-related stress. She experiences difficulty falling asleep about twice a week but denies waking up in the middle of the night. Denies other psychological symptoms, such as depression or mood swings.
ROS:
PMH/PSH:
Medications:
Physical Examination:
Diagnosis: Generalized Anxiety Disorder (mild).
Lifestyle modifications including improved sleep hygiene and relaxation techniques. Follow up in 4 weeks to assess progress.
Time spent: 20 minutes face-to-face.
Electronically signed by,
[Provider name, Credentials, Date signed]
Reimbursement rates for sessions billed with 99202 will vary depending on factors like the specific payer contract, your geographic location, and type of therapy license. Headway providers can check the portal for rates with each insurance provider.
This document is intended for educational purposes only. It is designed to facilitate compliance with payer requirements and applicable law, but please note that the applicable laws and requirements vary from payer to payer and state to state. Please check with your legal counsel or state licensing board for specific requirements.
90785 is an add-on code used to reflect communication difficulties during a psychiatric procedure, such as a psychotherapy session.
Both have their own distinct purpose, and you’ll need to understand each of them if you’re working with insurance.
Understand the ins and outs of CPT codes to help make documentation and billing more efficient — and give you more time to focus on other areas of your practice.