Use Caution When Reporting 90846 for Family Counseling

Medicare carriers require treatment of a mental health condition.

Myth: You can report a mental health counseling code any time you're counseling a patient's family member without the patient present.

Reality: Code 90846 (Family psychotherapy [without the patient present]) is specific to psychiatric services and does not always properly describe time the physician spends discussing a patient's condition.

Scenario: The wife of a Medicare patient presents for an appointment to discuss her husband's condition without him present because he is very sick and cannot come in. Medicare requires a face-to-face visit to report an E/M visit, so the practice cannot report an E/M code, but opts to report 90846 to describe the time spent counseling the patient's wife.

Solution: Medicare takes the view that talking to the family is bundled into the RVUs for office visits, so you can not charge the patient or the family for an additional visit about the patient's condition, says Quinten A. Buechner, M.S., M.Div., AAPC:CPC, BMSC:ACS-FP/GI/PEDS, ACMCS:PCS, PHIA:CCP, PAHCS:CMSCS, president of ProActive Consultants.

You can report 90846 only if the patient's wife suffers a mental disorder due to her husband's condition and she seeks psychiatric help for the condition. Some payers will reimburse the physician for treating the patient's family members for specific psychiatric conditions under 90846, but payer guidelines vary. Most carriers require a mental health professional to perform the service.

CMS' policy indicates that Part B payment for these services is paid on a "limited" basis.

In black and white: According to Medicare's Internet Only Manual (IOM) 100-03, chapter 1, part CIM 35-14, "In certain types of medical conditions, including when a patient is withdrawn and uncommunicative due to a mental disorder or comatose, the physician may contact relatives and close associates to secure background information to assist in diagnosis and treatment planning. When a physician contacts his patient's relatives or associates for this purpose, expenses of such interviews are properly chargeable as physician's services to the patient on whose behalf the information was secured. If the beneficiary is not an inpatient of a hospital, Part B reimbursement for such an interview is subject to the special limitation on payments for physicians' services in connection with mental, psychoneurotic, and personality disorders."

Bottom line: Check with your payer before reporting 90846, and only use it when the physician performs family psychotherapy.