CPT code 90885 is a specific billing code used in mental health for the psychiatric evaluation of records, reports, and other information concerning a patient's psychiatric status, without the patient being present. This code allows clinicians to be compensated for their time and expertise in reviewing a patient's history to inform diagnosis and treatment planning. Think of it as the essential background research a detective does before meeting with a client; it's the deep dive into existing data that informs the strategy. For instance, a psychiatrist might use this code to review extensive medical records from multiple providers, school records, and previous psychological testing to piece together a complex diagnostic puzzle for a new patient. This is particularly crucial in cases with comorbid conditions or a long history of treatment with varied success. Explore how a thorough records review can uncover previously missed details that could be pivotal to a patient's care plan.
Knowing when to use CPT code 90885 is key to compliance and appropriate reimbursement. This code is intended for a comprehensive review of records, not a cursory glance. It's best utilized when you are conducting a thorough analysis of a patient's psychiatric history to establish a diagnosis or create a treatment plan. For example, if you receive a new patient with a history of multiple hospitalizations and medication trials, you would use 90885 to bill for the time spent meticulously reviewing those records to understand their treatment trajectory. Consider implementing a practice policy that outlines the specific scenarios where 90885 is warranted, such as for all new patients with a complex history or when a significant change in treatment is being considered. This ensures consistency and defensible billing practices. According to AAPC, the provider reviews the medical records of the patient pertaining to psychiatric evaluation to help in establishing the diagnosis and treatment plan.
The ability to bill for CPT code 90885 is not limited to psychiatrists. A range of qualified mental health professionals can use this code, depending on state regulations and payer policies. This typically includes:
It's crucial to verify your eligibility with each payer, as some may have specific restrictions. For instance, a private practice psychologist might be able to bill a commercial insurance plan for a 90885 service, but the same service might not be covered by Medicare. Learn more about your state's specific regulations and individual payer policies to ensure you are billing appropriately.
It's easy to confuse 90885 with other psychiatric service codes, but understanding the distinctions is vital for accurate billing. Here’s a simple breakdown:
Think of it this way: 90885 is the review, 90887 is the conversation, and 90889 is the written report. For example, after reviewing a child's school and medical records (90885), you might meet with the parents to explain the findings (90887) and then write a comprehensive report for the school (90889).
Thorough documentation is the cornerstone of successful billing for 90885. Without it, you risk claim denials and compliance issues. Your documentation should be a clear and detailed record of the service provided. To ensure your documentation is robust, consider using a template that includes the following:
Documentation Element
Description
List of Records Reviewed
Specify each document reviewed, including the source and date (e.g., "Hospital discharge summary from General Hospital, dated 01/15/2025").
Time Spent
While not a time-based code, documenting the time spent on the review adds credibility and can be helpful in an audit.
Clinical Impressions
Summarize your findings and how they contribute to your understanding of the patient's condition.
Impact on Treatment
Clearly state how the information gleaned from the records will influence the patient's treatment plan.
For instance, you might write, "Reviewed 45 minutes of records from Dr. Smith, including a psychiatric evaluation from 2023 and medication records from 2022-2024. The records indicate a history of adverse reactions to SSRIs, which will inform our decision to explore alternative medication classes." Tools like Grammarly can help ensure your documentation is clear and professional.
Reimbursement for CPT code 90885 can vary significantly based on several factors, including the payer, your geographic location, and your contract with the insurance company. Here's a general idea of what to expect:
These figures are estimates, and it's always best to check the fee schedule for each specific payer. You can often find this information on the payer's provider portal. For example, Blue Cross Blue Shield in one state might reimburse at a different rate than Aetna in another. Explore how tools like PayerPrice can help you look up fee schedules and reimbursement rates for various billing codes.
A common question from clinicians is whether they can bill for a records review on the same day as a therapy session or other evaluation. In many cases, the answer is yes, as long as the services are distinct and separately documented. However, some payers may require a modifier to indicate that the services were separate and distinct. It's crucial to check with each payer for their specific rules. For example, if you have a therapy session with a patient in the morning and then spend time in the afternoon reviewing their records, you would document the time and activities for each service separately. Consider implementing a clear workflow in your practice to manage same-day billing scenarios, perhaps using a tool like Zapier to automate reminders for separate documentation.
Avoiding common pitfalls can save you time and prevent claim denials. Here are some of the most frequent errors to watch out for:
A helpful analogy is to think of billing for 90885 like a prescription: you need the right diagnosis (medical necessity), the right dosage (comprehensive review), and the right instructions (proper documentation) for it to be effective.
The detailed documentation required for 90885 can be time-consuming. This is where AI scribes can be a game-changer. An AI scribe can listen to your dictated summary of the records you've reviewed and transcribe it into a well-organized note that meets documentation standards. This not only saves you significant time but also improves the quality and consistency of your documentation. For example, you could dictate your clinical impressions and the specific records reviewed, and the AI scribe would format it into a professional note. Explore how AI scribes like S10.AI can streamline your documentation process and free up more time for patient care.
Can I bill CPT code 90885 for reviewing my own previous notes or just for records from other providers?
CPT code 90885 is specifically intended for the psychiatric evaluation of records, reports, and other data from external sources concerning a patient's psychiatric status. This means you should use it when reviewing documents from other clinicians, hospitals, schools, or facilities to inform your diagnosis and treatment plan. It is not appropriate to bill 90885 for reviewing your own previous notes, as this is considered part of standard, ongoing case management and is bundled into other service codes. Consider implementing a documentation workflow that clearly separates the review of external records from the review of your internal notes to ensure billing compliance.
What is the difference between CPT code 90885 and 90791, and when should I use each for a new patient evaluation?
CPT code 90885 is used for a non-face-to-face service where you are evaluating a patient's records without them being present. In contrast, 90791 is for a face-to-face psychiatric diagnostic evaluation. You would bill 90885 for the time spent conducting a deep dive into a new patient's complex history by reviewing extensive records from other providers before you meet them. Then, you would use 90791 for the initial intake interview with the patient. They are distinct services and should be documented as such. Explore how using an AI scribe could help you efficiently document the findings from your 90885 review, creating a clear, billable record of the service.
Is CPT code 90885 covered by Medicare and commercial insurance, and what are the typical reimbursement challenges?
Reimbursement for CPT code 90885 varies significantly between payers. While many commercial insurance plans will reimburse for this service, Medicare generally does not, as it considers the review of records to be part of the pre- and post-work of a face-to-face visit. A common pain point for clinicians is receiving denials due to a lack of clear documentation showing the medical necessity of the records review. To avoid this, your notes must explicitly state which records were reviewed and how that review directly influenced the patient's diagnosis or treatment plan. Learn more about individual payer policies and consider creating a documentation template to ensure all necessary components are included for successful reimbursement.