CPT Codes for Crisis Psychotherapy: 90839 & 90840

As a therapist, it’s appropriate to use CPT codes 90839 in instances where a client is in a life-threatening or complex situation. In this case, the client requires immediate attention and cannot be safely deferred or managed within a standard session.

CPT code 90839 is the foundational code for the first 60 minutes of crisis psychotherapy. 90840 may only be used in combination with 90839 to indicate that an additional30 minutes of crisis care has been provided.

When using 90839 and 90840, appropriate documentation is critical for reimbursement. Read more below on how to support compliance.

When to use 90839

1. There’s an immediate safety risk, including at least one of the following:

• Homicidal ideation (HI), current or historical.
• Active suicidal ideation (SI)
• Passive SI combined with sudden onset of SI, a plan and/or means of self harm, sharp escalation in severity of SI, recent triggering event, and/or severe emotional dysregulation

2. The situation is destabilizing rapidly, including several of the following criteria:

• Triggering event or acute stressor
• Severe emotional dysregulation with diminished capacity to cope
• Urgent need for care such that a delay would contribute to worsening of the situation
• Escalating risk trajectory
• Time-linked deterioration
  

Documentation requirements

The following five elements are necessary to include when documenting crisis psychotherapy under code 90839 and 90840.

1. Time

Record the exact start and stop times and total psychotherapy time. 90839 sessions are 30-74 minutes. Use add on code 90840 in addition to 90839 for sessions lasting at least 75 minutes.

2. Medical Necessity

Clearly state why a crisis session was necessary, including specific details about the acute risk and/or rapidly destabilizing situation. Explain why waiting until the next scheduled psychotherapy session would not have been sufficient.

3. Crisis Intervention

Document specific crisis-level interventions used to mitigate risk. Interventions should be clearly tied to crisis management and stabilization.

4. Safety Plan

Include a detailed and specific plan related to risk stabilization and immediate client safety.

5. Mental Status Exam (MSE)

Use MSE to further illustrate the client’s need for crisis intervention.

Common pitfalls to avoid

• Using 90839 when a client requests an additional session without an acute safety risk or rapidly deteriorating situation
• Standard follow up plans that do not focus on immediate stabilization
• Mental Status Exam that is all within normal limits
• Billing 90839 for sessions under 30 minutes

Takeaways

90839 is intended for situations requiring immediate intervention and should not be used as a catch-all for clients seeking an extra session. Clinical judgment is essential in determining whether a situation meets criteria for a crisis session, and appropriate documentation is required for reimbursement.