A family session is billed as work with the system around the identified patient. 90847 is family psychotherapy with the patient present. 90846 is family psychotherapy without the patient. Name who was in the room, the family-level intervention, how it supports the identified patient’s treatment plan, and nothing that belongs in a sister’s private chart.
If you find yourself writing the mother’s childhood trauma at length, you have slipped into the wrong record.
For an individual visit where a relative only drops in, use interpreter or collateral participation instead of 90846/90847.
Name the identified patient and who attended
Header: identified patient (name, DOB), attendees (name, relationship), who was absent, and whether the identified patient was in the room for all, part, or none of the time.
If the patient stepped out for 20 minutes so you could coach parents, write the split. That split may change the code. Do not bill 90847 for a session the patient never joined.
Consent: the adult patient agreed to this family session, or the minor’s legal guardian status is clear. Secrets policies (“I will not keep safety secrets”) belong in one sentence if you stated them.
Choose 90846, 90847, or an individual code honestly
90847: patient plus family, psychotherapy directed at the family system.
90846: family without the patient. Some payers still resist 90846. If yours does, know that before you book a parents-only hour and then panic-bill 90834.
90837 with a collateral in the last 10 minutes is still individual psychotherapy if the work was the patient’s. Do not upcode to 90847 because two people were on the Zoom.
90785 (interactive complexity) is for communication factors that complicated the service, not a family surcharge.
Time: start/stop or total minutes. Family codes are timed like other psychotherapy. Under 16 minutes is not a psychotherapy bill.
Keep other people’s therapy out of this chart
The identified patient’s record may contain family observations that explain the patient’s illness and the intervention. It may not become a second intake on the brother.
Do not assign the brother a DSM diagnosis in this chart. Do not paste his PHQ-9. Do not write a full trauma narrative that he did not agree to store in his sibling’s file. “Brother reports weekly cannabis use and agreed to stop bringing it to the house” is enough if the clinical point is household access.
If a family member needs their own care, document a referral and, if they are already your patient, write that work in their chart after a separate encounter.
Chart the family intervention and the patient’s goal
Name the model if you use one (structural, behavioral parent training, EFCT, multifamily psychoeducation) and the specific move today: mapped expressed emotion, practiced a 10-minute check-in, set a means-restriction plan with the parents.
Tie it to the identified patient’s goal: adherence, less EE at dinner, support for exposure homework, safer storage of lithium and a firearm.
Response: who engaged, who stonewalled, what was agreed. Plan: next family session vs return to individual, and what the identified patient will still do in their own hour.
Risk disclosures from family (new SI they observed, missing meds) go into the identified patient’s risk section, with the source labeled, plus what you did before they left.
Sample family-session note
CPT 90847, 50 minutes. Identified patient present entire session.
Attendees: patient; mother; father. No siblings.
Focus: expressed emotion at dinner driving weekend self-harm urges
(patient's treatment-plan goal 2).
Intervention: mapped last Friday's argument; practiced a 20-minute
pause-and-return script; parents agreed not to debate self-harm
content at the table.
Patient response: participated, corrected parents twice, agreed to
use distress-tolerance skills before joining a restarted argument.
Family response: father skeptical, agreed to try two dinners.
Risk: parents report no new method access; lockbox still in use.
Plan: individual session 8/3 as usual; family again in 3 weeks.
Mother requesting her own therapist: referred to clinic intake,
not treated in this encounter.Questions people ask
The parents want a copy of the note. Follow ROI and minor-consent law. Do not send a note that quotes the patient’s private individual sessions just because the parents paid.
Can I bill two family codes if I also saw the patient individually the same day? Sometimes, if both services are documented and payable on the same date under that payer. Many will bundle. Document both services as if they will be unbundled, then let billing apply the payer rule.