Clinicians and Crisis CPT Codes

You’re an independent therapist, or perhaps you work for an agency. One of your clients arrives for her weekly session and Whoa! This is gonna be a tough one because she’s clearly in crisis.

Well, you certainly know the steps:

… Assess risk, mental status and medical stability
… Decide if there’s a need for further evaluation or referral to another mental health service
… Communicate as you are able with anyone else who may have pertinent information, and
… Determine whether there’s been any substance use

Depending on any affiliate or employment status you have, there may be other steps.

And, of course, document each of the above.

The documentation is important not just for your own clinical use or that of anyone else who may have a need to know, but for billing purposes.

When a client with a private insurance (non-Medicaid) presents with a clinical crisis, the billing code changes from the standard CPT office visit code of 90837 to 90839 for the first hour, and 90840 for any half hour segments beyond that.

If you bill 90837 for the first hour and 90840 for any additional time, you won’t be reimbursed for the subsequent time as it’s considered an inconsistency in billing.

Stay tuned for more on CPT codes!

Categories: CPT Codes

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