Providing emergency care for a patient in crisis can be stressful, and figuring out how to bill for the session afterwards only adds additional strain. Don't worry: We're here to help.

Here's what you need to know about crisis CPT codes, 90839 and 90840.

What are 90839 and 90840?

The CPT codes 90839 and 90840 are used for emergency sessions with patients who are in high distress and under complex or life-threatening circumstances that demand immediate attention. Examples of this may include patients who display suicidal intent, disabling anxiety, or other overwhelming psychological symptoms.

It's important to note that 90840 is an add-on code that must be used in conjunction with 90839. In a crisis scenario, 90839 is billed for the first 60 minutes (though it can be used for 30-74-minute sessions), and 90840 is billed for each additional 30 minutes. Using both of these codes together requires that the session lasts 75 minutes or longer. If you don't meet the time required to bill one or both of these two crisis codes, you can bill the standard CPT code for the session, such as 90832 (Individual psychotherapy, 30 minutes).

How to handle a crisis

According to the CPT manual, 90839 and 90840 report an urgent assessment, which includes a history of a crisis state, a disposition, and a mental status exam. Treatment should include:

• Psychotherapy
• Mobilization of resources to defuse the crisis and restore safety
• Provision of psychotherapeutic intervention to minimize emotional trauma

Some states have more specific requirements for how therapists should handle a crisis, so make sure you check your local guidelines.

Documenting medical necessity

When billing crisis codes, make sure the following is mentioned in your documentation, and that it's clear and easy to find:

• A preliminary assessment of risk, mental status, and medical stability
• The need for further evaluation or referral to other mental health services (if applicable)
• Communication with contacts who may have pertinent information for the assessment
• Substance use (if applicable)
• Outcome of the session

While there are many different scenarios that call for crisis intervention, one of the common presentations is suicidal ideation.  A great resource is the SAFE-T, though many other resources are available as well.

Billing to insurance

In general, 90839 can only be reported once per day, though the time does not need to be continuous, and depending on the payer, 90840 may have limits on how many times per day it can be reported. You may also be limited by how many times per month or year you can bill these codes, depending on where you provide service. Check your local regulations.

Because 90839 and 90840 are used for crises, you can't bill these codes in conjunction with the following standard therapy codes:

• 90791 and 90792 (initial evaluations)
• 90832, 90834, and 90837 (psychotherapy)
• 90875 (interactive complexity)

Medicare doesn’t always reimburse crisis situations, and other carriers make their own decisions about whether to cover them. Because of this, APA Practice Organization recommends listing the fee you think is appropriate for the session, with the understanding that it may not be covered by Medicare and that private insurers may limit the amount you can bill.

We’ll cover other codes in future posts, so make sure to subscribe to the TherapyNotes™ blog for more.

Sources: CPT® (Current Procedural Terminology), American Medical Association; More Q&As about the New Psychotherapy Codes, APA Practice Organization; More FAQs on payment for psychotherapy codes, APA Practice Organization; Interactive Complexity, American Academy of  Child & Adolescent Psychiatry; Behavioral Health CPT Code Changes for 2013, Anthem Insurance Companies; Most Frequently Used CPT* Codes, National Association of Social Workers; Medical Necessity Criteria, Magellan Health; SAFE-T, Substance Abuse and Mental Health Services Administration

* The content of this post is intended to serve as general advice and information. It is not to be taken as legal advice and may not account for all rules and regulations in every jurisdiction. For legal advice, please contact an attorney.