Psychiatry billing is unique in that in addition to consultations, assessments and hospital visits, there are treatment codes which are billed according to the amount of time spent with the patient. These are the codes most commonly billed in this specialty, and offer a fair amount of leeway when compared with the more restrictive assessment codes.
Psychotherapy vs Psychiatric Care
Psychotherapy is essentially one-on-one treatment between the Physician and patient that treats mental illness, emotional and/or behavioural disorders. The goal is to change disturbing behaviours or improve the patient’s wellbeing. On the other hand, Psychiatric care is a combination of treatment and assessment for mental illnesses which include biological or psychosocial aspects. For billing purposes, psychotherapy is not readily replaced by any other code. Psychiatric care, however, includes the element of assessment which is common to consultation/assessment codes. It is at the physician’s discretion whether to bill consultation/assessment or psychiatric care depending on the circumstances.
Outpatient treatment codes
K197 ($80.30/unit) – Out-patient Individual Psychotherapy
K195 ($91.10/unit) – Out-patient Family Psychotherapy
Family psychotherapy takes place with the patient and the patient’s family present.
K198 ($80.30/unit) – Out-patient Individual Psychiatric Care
K196 ($91.10/unit) – Out-patient Family Psychiatric Care
Family Psychiatric Care is psychiatric care that takes place in the presence of the patient’s family or caregivers.
- If billing Individual and Family codes on the same day, a manual review clarifying that there were separately booked appointments for each code must be submitted with the claim.
- The time billed for out-patient treatment must be consecutive.
Inpatient treatment codes
K190 ($84.15/unit) – In-patient Individual Psychotherapy
K193 ($95.45/unit) – In-patient Family Psychotherapy
Family psychotherapy takes place with the patient and the patient’s family present.
K199 ($92.60/unit) – In-patient Individual Psychiatric Care
K191 ($105.10/unit) – In-patient Family Psychiatric Care
Family Psychiatric Care is psychiatric care that takes place in the presence of the patient’s family or caregivers.
- For inpatient treatment, family and individual therapy can be billed on the same day without any manual review.
- In-patient treatment time can be consecutive or non-consecutive.
- Treatment codes cannot be billed the same day as a subsequent visit (C192 – $31.00)
Time Units
The time units are relatively straightforward. Psychiatrists typically bill between 1 and 4 units per patient per day. Though there is no set maximum, be prepared to submit medical notes supporting the amount of time spent with the patient if you are billing 5 units or more.
| Time Units | Minimum Time with Patient |
|---|---|
| 1 unit | 20 minutes |
| 2 units | 46 minutes |
| 3 units | 76 minutes |
| 4 units | 106 minutes |
| 5 units | 136 minutes |
| 6 units | 166 minutes |
| 7 units | 196 minutes |
| 8 units | 226 minutes |
If your visit with the patient doesn’t meet the 20 minute minimum requirement, for out-patient psychiatric care you can bill a partial assessment (A194 – $38.05). For in-patient treatment, a subsequent visit (C192 – $31.00) would be appropriate for less than 20 minutes.
Stay tuned for our upcoming blog on “Premiums for Treatment Codes”