Psychiatry CPT Coding Changes

for 2013

Presented by Richard Morgenstern, M.D. Clinical Director, ICANotes

The First Big Change 90862 (Pharmacologic Management) is eliminated and replaced

with Evaluation and Management (E/M) codes*

Why this change is good:

– 90862 paid a fixed fee regardless of how complicated the case was. E/M codes pay higher fees for moderate and high complexity cases.

• 90862 rate was $50.49 • 99214 rate is $84.29**

– Also, whatever the complexity, with some documentation diligence a moderate level of complexity reimbursement level can always be achieved. (More on this later)

* Please note: these codes are for prescribers only.

**Source: http://www.ncdhhs.gov/dma/fee/phy_fee/phy_fee_sch110112.pdf

The First Big Change 90862 replaced with E/M codes

Why this change is bad:

– E/M coding is complicated! It depends on: What documentation history elements are in your note (severity of symptoms,

timing, etc.)

How many exam elements are in your note (mood, memory, judgment, etc.)

The complexity of the case

– The number of documentation elements required varies from site to site. Offices, nursing homes, and hospitals all have different requirements.

– You practically need a computer to keep track of where you are, what elements are in your note, and what code is supported.

The First Big Change

90862 replaced with E/M codes

Why this change is not so bad:

– Because some computer programs, including ICANotes, can keep track of: what documentation is in your note where you are working and what E/M code is supported

(more on this later)

The Second Big Change 90801 (Psychiatric Diagnostic Interview) has been eliminated and

replaced by codes that distinguish between Initial or Complete Evaluations done by prescribers and those done by non-prescribers

– The new codes are: 90791 for non-prescribers and 90792 for prescribers

(Yes, complexity code +90785 can be added here)

Presumably two different compensation levels will be offered

Both 90791 and 90792 can be billed on the same day

The Third Big Change Psychotherapy Code Changes!

– The following psychotherapy codes are being eliminated: 90804-90809 (Psychotherapy with E/M Services, outpatient) 90810-90815 (Interactive Psychotherapy) 90816-90822 (Psychotherapy with E/M Services, inpatient) 90823-90829 (Family Psychotherapy) 90857 (Interactive Group Psychotherapy)

(Note: 90853 Non-Family Group Psychotherapy may still be used)

– There will be three new psychotherapy alone codes in all settings that are dependent on time spent face-to-face with the patient and/or family (this is new; it used to be just time spent with the patient) How much time? What codes?

90832 30'' (16''-37'') 90834 45'' (38''-52'') 90837 60'' (53''+ )

The Third Big Change Question: What about the Psychotherapy with E/M service

codes: How do we bill for that now? Answer: Bill for the E/M service and Bill for Psychotherapy using an “Add-On” Psychotherapy code Add-On codes for Psychotherapy when using E/M services:

+90833 30'' (16''-37'') +90836 45'' (38''-52'') +90838 60'' (53''+ )

This is better than the old psychotherapy with E/M services because

the E/M code is adjusted for complexity (unlike previously) and the psychotherapy add-on is adjusted for time (as before)

Psychotherapy Add-On’s These can be used with the new psychotherapy codes or the psychotherapy

codes used in conjunction with E/M Services – The “+” identifies it as an add-on code but is not used when submitting the charge – 90785 amplifies other services; it never stands alone.

Interactive Complexity Add-On: This replaces 90810-90815

+90785 As the name implies, this add-on code can be used when the psychotherapy interaction is more complex

than normal communication problems. For example, the patient is “highly reactive” perhaps because of “high anxiety, repeated questioning, or disagreement.”

Examples: For Play Therapy When communication problems exist When a translator is needed When there is a “maladaptive communication” that complicates therapy as described above When caregiver problems compromise treatment When a “sentinel event” requires extra work and reports (such as with indication of abuse or neglect when a

report is mandatory)

Note: the reason for the additional complexity must be documented, of course!

Psychotherapy Add-On’s

Patient In Crisis Add-On: +90839 60 minutes (53'' -74'') +90840 each additional 30''

– “The presenting problem would be typically life threatening or complex and require immediate attention to a patient in high distress.”

– Note: These codes are for non-prescribers. A prescriber would indicate the higher complexity by using a high complexity E/M code.

Three Codes?!

Yes, some sessions will require as many as three codes! For example:

– an E/M code with complexity included (99213) – a psychotherapy code (90836) – and an interactive complexity code (+90785)

A Good Question What about existing contracts with insurers for specific codes?

Answer: (from the APA website) “The APA has been contacting major insurers to help ease the transition to the new codes. New contracts may need to be drawn up that reflect the new set of codes. Insurers may use a crosswalk from the old codes to the new so that no negotiations will need to take place. In fact, even now, under parity, all insurers should reimburse psychiatrists when they bill using one of the E/M codes, which are used by all physicians.”

Summary of 2013 CPT Coding Changes (Source: APA)

CPT® five-digit codes, descriptions, and other data only are copyright 2011 by the American Medical Association (AMA). All Rights Reserved.

Initial Psychiatric Evaluation (formerly 90801 or new patient E/M code) 90791, Psychiatric Diagnostic Evaluation (no medical services) 90792, Psychiatric Diagnostic Evaluation (with medical services) (New patient E/M codes may be used in lieu of 90792)

Psychotherapy (formerly 90804-90808, 90816-90821) For use in all settings; time is with patient and/or family)

90832, Psychotherapy, 30 minutes 90834, Psychotherapy, 45 minutes 90837, Psychotherapy, 60 minutes

Evaluation Management (E/M) and Psychotherapy (formerly 90805-90809, 90817-90822)

Appropriate E/M code (not selected on basis of time), and

90833, 30-minute psychotherapy add-on code Appropriate E/M code (not selected on basis of time), and

90836, 45-minute psychotherapy add-on code Appropriate E/M code (not selected on basis of time), and

90838, 60-minute psychotherapy add-on code Medication Management (formerly 90862 or E/M code)

Appropriate E/M code (99xxx series) Interactive Psychotherapy (formerly 90802, 90810-90815, 90823-90829, 90857) For use with the psychiatric evaluation codes, the psychotherapy and psychotherapy add-on codes, and the group (non-family) psychotherapy code

90785, Interactive Psychotherapy Crisis Psychotherapy (new)

90839, Psychotherapy for Crisis, first 60 minutes (Appropriate E/M code may be used in lieu of 90839)

90840, Psychotherapy for Crisis, each additional 30 minutes

Crosswalk Table

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