Health Information Management

Tip: Review guidelines for add-on code for interactive complexity for psychotherapy

APCs Insider, May 10, 2013

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The term "interactive complexity" means that the provision of psychiatric services has been complicated by a dysfunction of the patient's ability to communicate with the physician and participate in the process of diagnosis and treatment. Factors that may interfere with the delivery of psychological services include:

  •  Emotional and/or acrimonious family members
  •  Verbally impaired or undeveloped patient
  •  Patients with a third-party involvement such as those with another individual legally responsible for the patient's care, the need for an interpreter (language translator), child welfare agency representative, parole/probation officer, school ­official, etc.
The AMA has identified four qualifiers. The provider must document at least one of these to support the reporting of add-on code 90785:
Need to manage maladaptive communication among participants that complicates delivery of care
  • Caregiver emotions or behavior that interferes with the caregiver's understanding and ability to assist in the implementation of the treatment plan
  • Evidence or disclosure of a sentinel event and mandated report to a third party with initiation of discussion of the sentinel event and/or report with patient and other visit participants
  • 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 healthcare professional, and a patient who:
    •  Is not fluent in the same language as the physician or other qualified healthcare professional
    • Has not developed, or has lost, the ability to explain his or her symptoms, the ability to understand the physician, or is unable to respond to treatment
This add-on code to report interactive complexity (90785) may be used in conjunction with almost any other psychotherapy codes except 90839 and 90840 (psychotherapy in crisis). This code may not be reported accompanying an E/M service code without the concurrent provision of psychotherapy services codes.
The tip is adapted from “This month’s coding Q&A” in the April Briefings on APCs.

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