AI and Automation: They're Coming for Our Coding Jobs, and They're Bringing Coffee! ☕️ I'm not going to lie, the world of healthcare billing is often a tangled web of codes, modifiers, and acronyms. But just like that episode of "Friends" where Monica accidentally said "pivot", AI and automation are entering the scene and about to shake things up. It's happening whether we like it or not, so we might as well learn to embrace it. Joke time: What did the medical coder say to the physician after they had a long discussion about what code to use for the patient's visit? "Can we just get a refund on all the time we just spent talking about this?" Let's explore how AI and automation are poised to change medical coding and billing.

What is the Correct Code for Multiple-family group psychotherapy in Medical Coding?

This article explores the correct code and possible modifiers for multiple-family group psychotherapy sessions. This can be a complex area of medical coding. So let's break down a couple of typical scenarios to help US get a good understanding.

Scenario 1: The Initial Session

Imagine you are a medical coder working in a psychiatric practice. You are presented with a chart of a family of four, the mother, father, and their two teenage children. They are coming in for their first multi-family group therapy session to address the ongoing struggles they have been experiencing as a unit. What codes should you select?

Code 90849: Multiple-family group psychotherapy

Code 90849 in CPT® is the specific code to describe these psychotherapy sessions. However, we need to ask a crucial question here. How long was this first session?

If the initial family session was over 50 minutes long, we will use code 90849 as our primary code.

But, if this first session was less than 50 minutes, we would need to use the modifier -52.

What is modifier -52? Modifier -52 means "Reduced Services". It signals that the service was not delivered in the normal, standard time allotment for the specific procedure code. For instance, in the case of a typical psychotherapy session, 50 minutes is generally considered a "full session." If this initial session is only 40 minutes, we would need to reflect that by appending -52 to code 90849.

Modifier -52 - Reduced Services

The physician documentation is critical! Make sure it's very clear in their notes that the service was performed, and the documentation also provides a good reason as to why it was less than a full-length session. Here is an example of a note that might meet this need for the initial therapy session.

"The patient and her husband presented today for their first joint multi-family group therapy session. They were initially very hesitant and expressed their anxiety about group therapy. They took some time to settle in, and this resulted in a slightly shorter session at 35 minutes. They seemed comfortable by the end and have expressed an interest in coming back. Treatment goals have been identified, and a treatment plan is outlined and discussed."

Scenario 2: The Ongoing Session

We will stick with this same family, but now, imagine the sessions have been ongoing. The therapist indicates they will now be working with other family units with similar situations in the group sessions. They have decided that this is the best avenue for each group to learn and build rapport from their experiences.

In this case, we use the modifier -59, Distinct Procedural Service. Why? This modifier signals that the therapy service you are coding is "distinct" in some way from a service reported on a different day. When a different set of families is brought into the group sessions, the overall patient mix of the group has been altered; thus, it makes this subsequent group session a "distinct" service. It is critical to highlight this distinction in the coder's notes. For instance, the physician might mention a new intake questionnaire for each new family in the group.

Modifier -59 - Distinct Procedural Service

Here is a note example showing the distinction that the modifier -59 clarifies:

"Patient and spouse attended a group therapy session with a new group of families. The session today was an hour and 15 minutes. The families participated well in discussing individual treatment goals, building connections and sharing resources with each other."

The note above reflects how this session is Distinct from sessions previously billed because of the new group of patients participating in this session. The therapy performed today is still 90849. However, to reflect this distinction, we add the modifier -59.

Scenario 3: A Family is Not Ready for a Group Session

The mother is very apprehensive about joining the family group therapy session. The therapist suggests a shorter 15-minute session for her individually. What should we do?

The therapist may choose a different service code for the mother's individual session that is appropriate for a 15-minute timeframe. Or, they may bill for this 15-minute psychotherapy session by adding Modifier -53, Discontinued Procedure to code 90849, Multiple-family group psychotherapy.

Modifier -53 - Discontinued Procedure

If using 90849 for the mother's 15-minute session with the -53 modifier, the documentation should clearly describe that a full group session was not performed with her and why.

For instance, the physician documentation may state something like this:

"The patient’s husband and children joined the multi-family group psychotherapy session this morning. Due to the patient's nervousness around participating, she did not feel comfortable enough to join the group session. A shorter 15-minute individual session was conducted with her to help alleviate her anxiety around the concept of multi-family group therapy. She appears more relaxed and will discuss rejoining the session at next week's appointment."

Important Reminder Regarding Medical Coding and CPT® Codes

The information in this article should not be used as a substitute for seeking the advice of a qualified medical coder who holds an active license with the American Medical Association to use CPT® codes. CPT® is a proprietary product owned by the American Medical Association and using these codes for billing is a privilege granted with a license purchase from the American Medical Association. The use of the current editions of the AMA's CPT® is the responsibility of each medical coder, as it is a violation of United States federal law to submit incorrect codes to a government or private health plan. In addition, any improper billing is subject to both civil and criminal penalties and prosecution under U.S. law. You can learn more about CPT® codes at the American Medical Association's website.

Learn how to accurately code multiple-family group psychotherapy sessions using CPT code 90849. This guide explores common scenarios, including initial sessions, ongoing sessions with new families, and individual sessions with reluctant participants. Discover the importance of modifiers like -52 (Reduced Services), -59 (Distinct Procedural Service), and -53 (Discontinued Procedure) for accurate billing. Understand the crucial role of clear documentation for compliance and avoid costly billing errors. Explore the power of AI and automation in medical coding to streamline processes and ensure accuracy.

What are the CPT codes for multiple-family group psychotherapy sessions?