Documentation for CPT code 90847 (Family Psychotherapy with Patient) must meet specific time and complexity requirements while capturing essential clinical information. Using the SIRP Notes format for 90847 billing requires understanding how this note structure aligns with CPT documentation requirements.
SIRP 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 SIRP 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 SIRP Notes for CPT 90847
The SIRP Notes format maps well to CPT documentation requirements when each section contains the required elements:
Situation
Document relevant information for this code's requirements.
Intervention
Document relevant information for this code's requirements.
Response
Document relevant information for this code's requirements.
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 SIRP Notes For CPT 90847
I - Intervention: Therapist facilitated conjoint family psychotherapy focused on improving communication, identifying interaction patterns that intensify conflict, and supporting mutual problem-solving. Interventions included reflective listening coaching, reframing blame statements into needs-based language, and guided practice using a structured turn-taking format. Therapist also assessed for safety concerns and clarified that the session involved active clinical treatment of the relational stressors affecting the identified client’s functioning.
R - Response: Both participants were engaged and able to identify triggers for escalation. Client demonstrated improved ability to state concerns without interrupting, and spouse successfully paraphrased client’s concerns with minimal prompting. Each acknowledged that the exercise reduced tension in session. They remained ambivalent about change but agreed the communication structure was helpful and relevant to their ongoing relational distress.
P - Plan: Continue weekly 90847 conjoint sessions to address communication patterns and support improved co-parenting coordination. Homework assigned: each partner will use the turn-taking script during one planned discussion and track what helped de-escalate conflict. Next session will review progress, assess ongoing safety, and continue focused family therapy aimed at reducing relational stress and improving functioning in the household.
Example only. Replace with session-specific details.
Documentation Considerations for SIRP Notes For CPT 90847
Medical Necessity Must Be Tied To Relational Impairment
For CPT 90847, the documentation should show that the conjoint session was medically necessary to treat the identified patient’s mental health condition through family interaction. Payers expect more than a relationship update; describe how family dynamics are worsening symptoms, impairing functioning, or interfering with treatment progress. If the session addresses depression, anxiety, substance use recovery, or another diagnosis, connect the family work directly to that clinical need.
Document Time And Session Scope Precisely
CPT 90847 is a time-based psychotherapy code, so the note should clearly reflect the total face-to-face duration and that the billed time was spent in conjoint family therapy. Include who attended, whether the full session was completed, and that the intervention was psychotherapy rather than case management, education only, or a collateral contact. If there was any interruption or partial attendance, document it carefully because auditors often scrutinize this code for time accuracy.
Watch Payer Rules About The Identified Patient
Many payers require that the identified patient be present for 90847, and some distinguish it from family counseling or collateral services. Notes should make clear which person is the patient under treatment, the relationship of the other participant(s), and how the session served the patient’s treatment plan. Avoid wording that suggests the session was solely for the benefit of family members or focused only on parenting advice without clinical psychotherapy content.
Common Audit Triggers Include Vague Goals And Nonclinical Content
Auditors often flag 90847 notes that read like general family discussion, life coaching, or coordination of care. To reduce risk, document a clear therapeutic goal, specific interventions used, observable response, and follow-up plan. Avoid generic phrases such as “processed issues” without describing the clinical target. Also be cautious when using SIRP notes for this code—each section should show active psychotherapy, symptom-related need, and the patient-centered purpose of involving family members.
FAQ — SIRP Notes For CPT 90847
What must be documented in a SIRP note for CPT 90847 that is different from individual psychotherapy notes?
A 90847 SIRP note should show that the service was conjoint family psychotherapy and that the session was directed toward the treatment of the identified patient’s mental health condition. Document who attended, their relationship to the patient, the clinical reason for involving them, and how family dynamics affected symptoms or functioning. You should also capture the interventions used in the family setting, the participants’ responses, and a plan that continues treatment through conjoint work.
How specific does the time documentation need to be for CPT 90847?
Be very specific. CPT 90847 is a timed psychotherapy service, so the note should reflect the actual face-to-face duration and ideally confirm that the full session was spent in conjoint psychotherapy. If your practice uses start/stop times, include them. If a payer audits the claim, they will look for proof that the billed duration matches the service delivered and that the encounter was not mainly administrative, collateral, or educational rather than psychotherapy.
Can I bill 90847 if only one family member talks most of the session?
Yes, as long as the session is still conjoint family psychotherapy with the identified patient present and the clinical focus remains the patient’s treatment. One participant may talk more, but the note should show that both were involved and that the therapist actively treated the relational or family-system issue affecting the patient. If the encounter becomes primarily individual therapy with a family member present but not clinically engaged, 90847 may not be appropriate.
What are the most common reasons a 90847 claim gets denied or audited?
Common problems include missing time documentation, failure to identify the patient, vague notes that do not show medical necessity, and documentation that looks like general family counseling rather than psychotherapy. Payers may also deny claims when the note does not show active treatment of a mental health condition, when the session is mostly collateral or care coordination, or when the required participant presence is not clear. Strong SIRP notes reduce these risks by linking the family work to the patient’s treatment plan.
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Further Reading
- CMS Documentation Requirements — Provides official guidelines on documentation standards required for CPT code billing and compliance.
- APA Documentation Guidelines — Offers detailed recommendations on clinical documentation practices relevant to psychotherapy notes.
- HHS HIPAA — Outlines privacy and security rules essential for maintaining confidentiality in psychotherapy documentation.