Considerations for Couples Counseling

Written by Kelsey Someliana-Lauer, TPS Virtual Assistant

It’s Valentine’s Day, and what better day to talk about couples counseling?  Couples counseling is increasingly popular in America with nearly half of all couples reporting they’ve utilized the services of a couple’s counselor while together.  Of those couples, nearly two-thirds - 66 percent - have reported benefits of attending counseling in less than twenty sessions.  

With couple’s counseling being an extremely popular form of counseling, you may be wondering - what is the process of adding couple’s counseling as a service my practice offers? Do I need any specialized training?  What does billing couples clients look like? Scheduling and legality considerations? Notes?

Not to worry - the pros at Therapy Practice Solutions can help out with these questions! Check out our tips below for considerations for couple’s counseling.

Scheduling and Legalities

When you’re scheduling couples clients, it may look a little different depending on which EHR you’re using. Some electronic systems allow you to set an appointment as a couples session specifically - for example, here is a guide from SimplePractice on how to set an appointment for a couple. Other EHRs, however, don’t have this ability; for example, in TherapyNotes and Theranest you’ll have to set one individual out of the couple as the “identified client” (more on this in our billing section below).

Regardless of if your couples clients are listed as an individual or a couple on your calendar, the legalities don’t change. You’ll need to collect from each member of the relationship:

  • Signed consent forms, like Informed Consent and Practice Policies

  • Signed payment authorization (at least from the client paying the fee, if they’re not splitting the cost)

  • Release of Information to be able to talk to the partner regarding scheduling and billing (this is just to cross your t’s and dot your i’s)

We’d recommend making a client file for each person and sending them each your full intake packet - even if you don’t need two separate intake questionnaires, it’s interesting (and therapeutically relevant) to see how their view of their problems differ from each other.

Billing Couples
Ah, insurance billing. Let’s start off by saying the obvious - if you’re a private pay clinician, all you’ll need to do is charge your couple the private pay rate. Simple, easy.

If you accept couples who want to utilize their insurance, you have a couple options.

  • Option 1: Bill the identified client’s insurance. When we say “identified client”, we mean the primary client - which is almost always the client who schedules the phone call. If you take this route, you would have this client’s card on file, their release to their insurance company, and their consent to send claims to insurance. Using this method, you would charge 90837, 90834, or 90832 as normal.

  • Option 2: Bill the “family therapy” code. This is code 90847 or 90846. While this is the best option, it isn’t covered by insurance under many plans. Even if you take this route, you’ll still need to charge a single client, and send an insurance claim to only one of the two individuals’ insurance.

To be as compliant as possible, we recommend billing the family therapy code, and if it isn’t covered by their plan, then taking the couple on as a private pay.

Writing a Couple’s Session Notes

When keeping documentation for a couple, you need:

  • Two assessments. While much of your information can be the same (such as presenting problem, their view of the problem, etc.), you’ll need a separate history for each clients. By history, we mean all the other stuff you ask about in an assessment - their leisure activities, educational history, developmental history, and more.

  • One treatment plan. The good news is - no need to write two different treatment plans. Make one treatment plan that encompasses their goal as a couple.

  • Two progress notes. Similar to the assessment, you can include some of the same language on each note (for example, “Therapist met with both clients for virtual session. Therapist and couple processed challenges of the week, including XYZ”). However, make sure to write two notes to account for different mental status exams and contributions in session (for example, you may write “Client A was agitated and spoke to Client B in an elevated tone” on Client A’s progress note, and “Client B responded tearfully when Client A spoke to them in an elevated tone” on Client B’s note).

What About Training?

The good news is - we’ve already created an entire blog post covering training modalities for working with couples. Read it here!

We hope this blog post helps you feel more confident in the logistics around offering couple’s counseling to your clients! If you want more support in implementing these changes, the pros at Therapy Practice Solutions are here to help. Reach out today to be paired with someone who can take your administrative tasks, marketing, social media creation, and more off your hands! We look forward to hearing from you.


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