Documentation for CPT code 90847 (Family Psychotherapy with Patient) must meet specific time and complexity requirements while capturing essential clinical information. Using the DAP Notes format for 90847 billing requires understanding how this note structure aligns with CPT documentation requirements.
DAP Notes Documentation for CPT 90847
Code Overview: CPT 90847
Service Description: Family Psychotherapy with Patient
Description: Family therapy session with the identified patient/primary client present, addressing family dynamics, relationships, communication, and systemic issues. Often used for conjoint therapy, family sessions, or multi-person sessions involving the client.
The CPT code 90847 carries specific documentation requirements that differ from other mental health service codes. Your clinical notes must clearly demonstrate that the service provided meets the definition of this code and justifies the complexity and time involved. The DAP Notes format provides an excellent structure for capturing this required information.
Documentation Requirements for CPT 90847
Essential Documentation Elements
- Chief Complaint or Reason for Visit: Clear statement of why the client is seeking services and what brought them to this session
- History of Present Illness: Detailed exploration of current symptoms, their onset, duration, and progression since last visit
- Relevant Medical/Psychiatric History: Background information affecting current treatment and functioning
- Current Symptoms and Status: Specific documentation of symptoms present and their severity or intensity
- Assessment/Diagnosis: Clear diagnostic formulation with DSM-5 codes and justification for diagnosis
- Functional Assessment: How symptoms affect occupational, social, and personal functioning
- Risk Assessment: If applicable, documentation of suicide risk, homicide risk, substance use, or other safety factors
- Treatment Interventions: Specific therapeutic interventions provided during this encounter
- Response to Interventions: How the client responded to treatment and progress toward goals
- Treatment Plan/Next Steps: Continuation of current approach or modifications based on client response
How to Document with DAP Notes for CPT 90847
The DAP Notes format maps well to CPT documentation requirements when each section contains the required elements:
Data
Include the client's presenting concerns, history of present illness, relevant background, current symptoms, and functional impact. This section should address "why is the client here today?" and establish medical necessity for services.
Assessment
Provide your clinical interpretation, diagnostic assessment with DSM-5 codes, risk assessment findings, and your clinical impression of the client's current status and progress.
Plan
Detail the treatment plan, specific interventions being provided, goals for ongoing treatment, and any modifications to the existing plan.
Common Documentation Mistakes for CPT 90847
- Vague Symptom Documentation: Avoid generic statements like "client reports doing okay." Be specific about which symptoms are present, which have improved, and which persist.
- Missing Time/Complexity Justification: Don't simply bill the code; document why this encounter required the time and complexity represented by the code you're billing.
- Insufficient Medical Necessity: Always connect symptoms to diagnosis and show how treatment addresses the documented symptoms and functional impairment.
- Incomplete Risk Assessment: If mental health treatment is involved, address safety. Document suicide risk assessment, substance use status, or other safety factors as appropriate.
- Generic Treatment Plans: "Continue current therapy" is insufficient. Specify what you're doing and why, with reference to the client's goals and presenting problems.
- Inconsistent Diagnoses: Ensure your billing diagnoses match your documentation. If you bill for depression, document depressive symptoms. If you bill for anxiety, document anxiety symptoms.
- Missing Progress Indicators: Show how the client is progressing. Compare to previous session, note improvements, identify barriers, adjust interventions based on response.
Audit Red Flags for CPT 90847
Insurance auditors and peer reviewers look for these red flags when reviewing claims for CPT 90847:
- Documentation that doesn't support the complexity or time of the code billed
- Inconsistency between diagnosis billed and symptoms documented
- Lack of progress notes over time (shows ongoing medical necessity)
- Missing risk assessment when treating mental health conditions
- Generic, template-like notes that could apply to any client
- No clear treatment plan or goals documented
- Inadequate functional assessment (documentation of how condition affects daily life)
- Notes that don't reflect the time reported (very brief notes for longer billing times)
Sample Note Example for Dap Notes For Cpt 90847
Assessment: Couple/family conflict continues to impair daily functioning and contributes to anxiety, sleep disruption, and reduced co-parenting effectiveness. Both participants were engaged and able to identify cycles of blame and avoidance. Symptoms and relational stressors remain clinically significant and support medical necessity for conjoint psychotherapy. No acute safety concerns identified today.
Plan: Continue weekly 53-minute family psychotherapy using conjoint sessions to reduce conflict, improve communication, and strengthen co-parenting coordination. Homework: practice 10-minute check-in using speaker-listener format twice before next session and track one successful repair attempt after conflict. Next session will review communication patterns and address problem-solving around evening routines.
Example only. Replace with session-specific details.
Documentation Considerations for Dap Notes For Cpt 90847
Document the Conjoint Therapeutic Purpose
CPT 90847 is for family psychotherapy with the patient present, so the note should make clear that the session was clinically directed at the identified patient’s treatment, not simply family education or mediation. Describe how family interaction patterns are affecting the patient’s symptoms, functioning, or recovery. Payers look for medical-necessity language showing that the family work is integral to treating the patient’s mental health condition.
Include Time Consistent With 90847
90847 is a time-based psychotherapy code and is typically billed when the session is at least 53 minutes. The note should reflect the actual face-to-face duration and avoid vague language like “spent time with family.” Document start and stop time or total minutes when your practice or payer requires it. Time should match the level of service billed and any supervision or ancillary activities should not be counted.
Watch Payer Definitions Of Family And Presence
Some payers interpret 90847 narrowly and expect the identified patient to be present for the full or substantial portion of the session. Others have rules about which relatives qualify and whether spouses, caregivers, or non-blood relatives count as family members. Confirm the payer’s policy and document who attended, their relationship to the patient, and why their participation was clinically necessary for the treatment plan.
Avoid Common Audit Red Flags
Auditors often question notes that read like couples counseling without a clear patient-centered diagnosis, lack individualized intervention, or show identical content across sessions. Another red flag is billing 90847 when the session primarily focused on one family member’s issues with the patient absent. Include objective observations, intervention details, patient response, and a clear plan tied to symptoms and functional impairment to support the code.
FAQ — Dap Notes For Cpt 90847
What must a DAP note include to support CPT 90847?
A strong 90847 DAP note should identify that the session was family psychotherapy with the patient present, specify who attended and their relationship to the patient, and describe the therapeutic focus on the patient’s mental health treatment. Include the session duration, the family dynamics addressed, the interventions used, the patient’s response, and a plan linked to reducing symptoms or improving functioning. The note should show medical necessity, not just family discussion.
How do I document time for CPT 90847 if I use DAP format?
In DAP format, time can be documented in the Data section or embedded in the note header if your organization uses that convention. The key is that the record clearly supports the billed duration for 90847, which is typically a 53-minute conjoint session. If your payer requires exact start/stop times, include them. Avoid billing based on scheduled time if the actual face-to-face psychotherapy time was shorter.
Can I bill 90847 if the identified patient participates only part of the session?
Maybe, but it depends on the payer and the clinical circumstances. Many payers expect the identified patient to be present for the family psychotherapy service, though some allow brief absence if clinically justified and documented. If the patient is absent for most of the session, 90847 may not be appropriate. Document exactly when the patient was present, why any absence occurred, and how the work still supported the patient’s treatment.
What are the most common denial reasons for 90847 claims?
Common denials include insufficient evidence that the service was psychotherapy for the patient, missing or unclear time documentation, lack of a patient diagnosis tied to the family work, and notes that read like generic family counseling. Denials also happen when the payer requires the patient to be present and the record does not show this, or when the session length doesn’t match the code. Clear clinical rationale and precise documentation reduce risk.
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Further Reading
- CMS Documentation Requirements — Provides official guidelines on documentation standards required for Medicare and Medicaid billing, including psychotherapy services.
- APA Documentation Guidelines — Offers detailed recommendations on clinical documentation practices relevant to psychotherapy and mental health services.
- SAMHSA — Contains resources on behavioral health documentation and best practices for mental health treatment providers.