What Clinicians Need to Know About the Interactive Complexity CPT Code (90785)

WHAT IS THE INTERACTIVE COMPLEXITY CPT CODE? WHEN SHOULD YOU USE IT?

According to the American Academy of Child & Adolescent Psychiatry, “interactive complexity refers to 4 specific communication factors during a visit that complicate delivery of the primary psychiatric procedure.” It is reported with the CPT add-on code 90785.

Many clinicians struggle with when to use the code and when not to use it. 90785 is an ‘add-on’ code which means it cannot be billed alone and has to be billed along with another CPT code for the same date of service.

It can be used with the following CPT codes:

• Psychiatric diagnostic evaluation, 90791, 90792  
• Psychotherapy, 90832, 90834, 90837  
• Group psychotherapy, 90853

You may not use the Interactive Complexity code with:

• Psychotherapy for crisis (90839, 90840)   
• Family psychotherapy (90846, 90847, 90849)

TYPICAL CLIENTS YOU WOULD USE THE CODE WITH:

You may see interactive complexity in sessions with patients who have a legally responsible caregiver. These patients could be children, adolescents, or adults who have a legal guardian.

Other cases where interactive complexity is often present are cases where there are interpreters or translators present for the patient.

It may also be present with patients where an adult brings one or more family members to participate in the session.  

Another common example is in the case of sessions that require the participation of a third party. This third party could be a child welfare agency, parole or probation officers, or schools (among others).

WHEN SHOULD YOU USE CPT CODE 90785:

You should use this CPT code when one or more of the following is present in a session:

• When delivery of care is complicated due managing maladaptive communication among involved parties.
  • Examples of maladaptive communication include:
    • high anxiety
    • high reactivity
    • repeated questioning or disagreement
• In a case where the implementation treatment plan is hindered due to caregiver emotions or behaviors.
• When a discussion of a sentinel event and/or mandated report to a third party is initiated with the patient and any other participants.
  • Child Services/Elder Abuse Services etc.
• When patients require equipment, devices, interpreters, or translators to work around impediments to diagnostic or therapeutic interaction with a patient.
  • Patients who require this include:
    • patients who are not fluent in the same language as the provider
    • patients who have not developed receptive language skills and are unable to understand typical language
    • patients who have lost receptive language skills and are unable to understand typical language.

According to the Center for Medicare and Medicaid Services (CMS), “90785 generally should not be billed solely for the purpose of translation or interpretation services” as that may be a violation of federal statute.

HOW TO BILL 90785:

• On a new claim line, put the same date of service as the main CPT code service date.
• Put 90785 as the CPT code
  • Do not put + on the code (the plus just means you cannot bill it alone.)
• Put your usual provider information (NPI 1, diagnostic pointer, name etc.) on the rest of the claim line.
• Typically providers bill this code around $15 or $20.
  • Reimbursement depends on your fee schedule.

Claim for with Interactive Complexity in addition to 90837

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