According to the American Academy of Child & Adolescent Psychiatry, “interactive complexity refers to 4 specific communication factors during a visit that complicates the delivery of the primary psychiatric procedure.” It is reported with the CPT Code 90785. Interactive Complexity (90785) is an add-on code specific for psychiatric services and refers to communication difficulties during the psychiatric procedure.
Add-on codes may only be reported in conjunction with other codes, never alone. Individual psychotherapy CPT codes should be used only when the focus of treatment involves individual psychotherapy. Psychiatric service CPT codes should not be used when other CPT codes such as an evaluation and management (E/M) service or pharmacological codes are more appropriate.
Although interactive complexity is common during visits by children and adolescents, it may also apply to adults. The specific communication difficulties are present with patients who typically:
- Have other individuals legally responsible for their care, such as minors or adults with guardians, or
- Request others to be involved in their care during the visit, such as adults accompanied by one or more participating family members or interpreter or language translator, or
- Require the involvement of other third parties, such as child welfare agencies, parole or probation officers, or schools.
Interactive complexity may be reported with psychiatric procedures when at least one of the following communication difficulties is present:
- The need to manage maladaptive communication (related to, e.g., high anxiety, high reactivity, repeated questions, or disagreement) among participants that complicates delivery of care.
- Caregiver emotions/behavior that interfere with implementation of the treatment plan.
- Evidence/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 and other visit participants.
- Use of play equipment, physical devices, interpreter or translator to overcome significant language barriers.
The following examples are NOT interactive complexity:
- Multiple participants in the visit with straightforward communication
- Patient attends visit individually with no sentinel event or language barriers
- Treatment plan explained during the visit and understood without significant interference by caretaker emotions or behaviors
When to use CPT Code 90785
When at least one of the following communication factors is present during the visit:
- The need to manage maladaptive communication (related to, e.g., high anxiety, high reactivity, repeated questions, or disagreement) among participants that complicate the delivery of care.
- Caregiver emotions or behaviors that interfere with the implementation of the treatment plan.
- Evidence or disclosure of a sentinel event and mandated report to a third party (e.g., abuse or neglect with a report to the state agency) with the initiation of discussion of the sentinel event and/or report with the patient and other visit participants.
- Use of play equipment, physical devices, interpreter or translator to overcome barriers to diagnostic or therapeutic interaction with a patient who is not fluent in the same language or who has not developed or lost expressive or receptive language skills to use or understand typical language.
Use in Conjunction With
The following psychiatric “primary procedures”:
- Psychiatric diagnostic evaluation, 90791, 90792
- Psychotherapy, 90832, 90834, 90837
- Psychotherapy add-on codes, 90833, 90836, 90838, when reported with E/M
- Group psychotherapy, 90853
When performed with psychotherapy, the interactive complexity component (90785) relates only to the increased work intensity of the psychotherapy service and does not change the time for the psychotherapy service.
May not report with
- Psychotherapy for crisis (90839, 90840)
- E/M alone, i.e., E/M service not reported in conjunction with a psychotherapy add-on service
- Family psychotherapy (90846, 990847, 90849)
You also generally shouldn’t bill the CPT Code 90785 code solely for the purpose of translation or interpretation services. That’s because, according to the Centers for Medicare and Medicaid Services (CMS), federal laws prohibit discrimination, “which in this case would take the form of higher beneficiary payments and co-payments for the same service, based on disability or ethnicity.” So, use discernment when billing for translation or interpretation services.
When billing for interactive complexity, your billing form needs to include both the primary service code and the interactive complexity code, one after the other. You should use the same date for both codes and explain what the interactive complexity was exactly.
For accurate Mental/Behavioral Health medical billing, knowing your CPT codes is the most important thing. In our blog series of ‘Know Your Codes’ or ‘KYC,’ we have discussed the most common CPT codes in detail and when to use them. E2E Medical Billing Services is known for it’s accurate Mental/Behavioral Health medical billing and coding. To know more about our services call us at 888-552-1290 or write to us at info@e2eMedicalBilling.com