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interactive complexity

Lisa_i 3 years ago in Billing/Electronic Modules updated by LWright 3 years ago 6

Hi all, Not sure I'm posting this in the correct forum. I'm looking for some information about coding for interactive complexity for clinicians doing play therapy. When adding this to 90837 or similar service line, do other clinicians typically record notes for both service lines or is a note for only one (or the other sufficient)? Our interactive complexity codes got denied and they were added at the same time as the main service code but notes were only included with the 90837 line so wondering if that was the problem. Any help with this would be welcome.

We use 90785 code for interactive complexity.   

Yes, we do as well, along with the 90837 or similar, but the 90785's have been getting denied and so I'm wondering if this is because of how we're doing our notes? Do you attach a note to each service line or is one for the main code sufficient?

We do not attach a copy of the note; however I have created an audit tool for our psych visits to ensure that they meet billing criteria.  Sorry, I cannot help you as we do not use that billing code.  We are billing as an outpatient clinic using 992XX codes. 

Lisa, may I ask which carrier(s) are denying?

The current President of the American Psychological Assoc, Tony Puente, PhD, is a CPT coding expert.  His website provides detailed info about coding issues. Regarding interactive complexity, he states: 

Interactive complexity, reported with add-on code 90785 (emphasis added), refers to specific communication factors that complicate the delivery of certain psychiatric procedures." (including the standard therapy codes) The amount of time billed for is determined by the "base code" (the code that 90785 is added to).

He goes on to list the the possible "interactive complexity" factors:

To report 90785 at least one of the following factors must be
present:
1. The need to manage maladaptive communication (related to, e.g., high
anxiety, high reactivity, repeated questions, or disagreement) among
participants that complicates the delivery of care.
2. Caregiver emotions or behavior that interferes with the caregiver’s
understanding and ability to assist in the implementation of the treatment plan
3. Evidence or disclosure of a sentinel event and mandated report to a third party
(e.g., abuse or neglect with report to state agency) with initiation of discussion
of the sentinel event and/or report with patient or other visit participants
4. Use of play equipment, other physical devices, interpreter or translator to
communicate with the patient to overcome barriers to therapeutic or diagnostic
interaction between the physician or other qualified health care professional
and a patient who;
    1. Is not fluent in the same language as the physician or other qualified health care
professional, or
   2. Has not developed, or has lost, either the expressive language communication skills
to explain his/her symptoms and response to treatment or receptive skills to
understand the physician or other qualified health care professional if he/she were to
use typical language for communication

Richard Sethre, PsyD, LP

www.mhconcierge.com




I would suggest checking your contract and fee schedule to make sure the CPT code is listed. I would then ensure the documentation requirements for that CPT code are met. If you can do both those things, and it is still getting denied, then I would take it to the Provider Contracting person to let them know clinically appropriate and medically necessary services are being denied.