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Interactive complexity for telemedicine?

Kim Ross 2 weeks ago in Codes/Rates/Diagnosis Modules updated by ahuseby 2 weeks ago 12

Good morning. 

As we bill telemedicine mental health and substance use disorder services for the foreseeable future, we have a question:


Because of the added complexity of the technology, is it appropriate to use the add-on code 90785?


Interactive complexity refers to factors that complicate the delivery of a mental health procedure, as defined:

You should use this CPT code when one or more of the following is present in a session:
  • When delivery of care is complicated due managing maladaptive communication among involved parties.
    • Examples of maladaptive communication include:
      • high anxiety
      • high reactivity
      • repeated questioning or disagreement
  • In a case where the implementation treatment plan is hindered due to caregiver emotions or behaviors.
  • When a discussion of a sentinel event and/or mandated report to a third party is initiated with the patient and any other participants.
    • Child Services/Elder Abuse Services etc.
  • When patients require equipment, devices, interpreters, or translators to work around impediments to diagnostic or therapeutic interaction with a patient.
    • Patients who require this include:
      • patients who are not fluent in the same language as the provider
      • patients who have not developed receptive language skills and are unable to understand typical language
      • patients who have lost receptive language skills and are unable to understand typical language.

Any insight is appreciated.

Thanks,
Kim

Can you tell me what platform your using for providing telemedicine for SUD and MH?

Following...

We are using Zoom.

Are MA and managed care plans reimbursing for this?  If so, do you have to add this to your contracts.

Reimbursing for 90785 or telehealth in general?

I think the original question is specific to "use of equipment or devices." For example if a clinician who uses EMDR equipment can bill a 90785. The question is due to use of computer/phone for treatment can 90785 be added for "use of equipment or devices"? 

Yes. Alyson. That is the correct interpretation of my question.


If the service, because it's telemedicine, can and should be billed with IC, then EVERY service that is eligible for IC can now be billed with IC because all our services are telemedicine!


Does anyone have insight or information? Or, a resource for information?


Thank again.

Best,
Kim 

I have not seen anything saying that we can use that code for tele therapy yet, so would perhaps test it out first or get confirmation from payers. I would just be happy to have all our tele therapy sessions reimbursed the same as in-person, which most payers seem to say will be happening. 

Does anyone know if we do use the 90785 for telemedicine, do we also use the GT modifier on it as well as the face to face code?

We have been told by our payers that any of the codes normally covered will be covered with telehealth. But, they do say the information they give may not reflect how claims are processed. As far as the modifier - we had to call all our payers individually; some use GT, some 95 and some don't require one.

So both codes would use the modifier (if they require one).  Ok thank you for the information.