Be Prepared for CPT Code Changes, APA Urges

Deborah Brauser

November 21, 2012

Major changes are coming quickly to the Psychiatry section of the American Medical Association's (AMA's) Current Procedural Terminology (CPT) codes, which are used for billing and documentation for all insurers.

The changes, which go into effect January 1, 2013, are leaving some clinicians scrambling to learn how the new codes should be used and what they can do now to start preparing their practices. These changes will likely affect billing processes, workflow, and even practice management systems.

Dr. Ronald Burd

"Clinicians really need to learn this coding," Ronald M. Burd, MD, a psychiatrist with Sanford Health in Fargo, North Dakota, and chair of the Committee on Resource-Based Relative Value Scale (RBRVS), Codes, and Reimbursements for the American Psychiatric Association (APA), told Medscape Medical News.

"I believe this is a physician responsibility and can't just be dumped off onto coders. For those who don't figure this out, I predict that bills sent out are going to be sent back and they'll have to redo the work," said Dr. Burd.

The APA and the American Academy of Child and Adolescent Psychiatry (AACAP) currently have a number of resources regarding the upcoming codes posted on their Web sites, including a "crosswalk" explaining the changes that will be taking place in 2013.

In addition, the National Council for Behavioral Health held a free Webinar earlier this month about the impact of these changes. It has uploaded audio and slides from the presentation onto their Web site and will be holding another live Webinar on December 3 to discuss how the changes will work with evaluation and management (E/M) codes.

"The question that keeps coming up is: will the implementation be delayed? And the answer is a strong no," explained Jeremy S. Musher, MD, president and CEO of the Musher Group in Pittsburgh, Pennsylvania, and a presenter during the National Council's first Webinar.

Big Impact

Dr. Jeremy Musher

Dr. Musher, who also represented the APA as an alternate advisor to the AMA's CPT Advisory Committee, noted that the last major change to the psychiatry codes was in 1998.

"As we all know, there have been significant changes in the practice of psychiatry and behavioral health in the last 15 years," he said.

Although the AMA makes annual changes to its CPT codes, "this year's changes have a much larger than usual impact on behavioral health services," noted a representative from the National Council during its presentation.

This could include affecting claim submissions, health information technology infrastructure, contracts with individual insurers, reimbursement rates for services, documentation, and various compliance issues.

Nevertheless, Dr. Musher, who is also the medical director for psychiatric emergency services at the Western Psychiatric Institute and Clinic at the University of Pittsburgh School of Medicine, said that the changes are much needed.

"There's been an increased intensity of services due to increases in patient comorbidities, and we've seen a tremendous shift from inpatient to outpatient settings," he said.

"We've also felt there's been an inadequate code structure to account for varying levels of psychotherapy and medical management. Also, the interactive psychotherapy codes were narrowly defined and inadequate to describe the work that's being done."

Deletions

A workgroup made up of members of US psychiatric organizations met throughout 2011 and part of 2012. They came up with recommendations that were then presented to the AMA's CPT Panel. The panel then voted and forwarded their recommendations to the Centers for Medicare and Medicaid Services (CMS).

In addition, the various psychiatric societies also participated in a relative value scale update committee (RUC) meeting, in which the new codes were valued. There, the organizations presented data from member surveys and expert panel recommendations. After voting, recommendations from this meeting were also forwarded to the CMS.

After receiving all recommendations, the CMS then made its proposed final decision on codes and their values. In September, the AMA adopted the new codes and noted that all changes must be implemented for services provided after January 1, 2013.

This means that insurers need to decide "which codes to continue to pay for and establish pricing. [But] they cannot continue to use CPT codes that have been deleted by the AMA," explained the National Council.

One of the biggest changes for psychiatrists will be the elimination of code 90862, which has been used for pharmacologic management. Instead, clinicians should use the appropriate E/M code.

"This is a code that has been used millions of times but is very vague. And it is going to be gone, gone, gone," said Dr. Burd.

"I think this is the most widely used code by psychiatrists for many years as the medication management follow-up code. So doctors will need to now familiarize themselves with E/M codes," added Dr. Musher.

Additions

In addition, there are now 3 timed codes for psychotherapy in all settings — 90832 for 30 minutes, 90834 for 45 minutes, and 90837 for 60 minutes.

There are also add-on timed codes, indicated by a "+" symbol, to signify that psychotherapy was done at the same time as an E/M service. For example: appropriate E/M code +90833 for 30 minutes or +90836 for 45 minutes. All of the timed codes should now be used to denote time spent with a patient and/or a family member.

Other changes include the following:

  • An initial evaluation by a physician is now 90792, and by a nonphysician, it is 90791;

  • The codes 90839 and +90840 have been added for psychotherapy for a patient in a crisis; and

  • The add-on code +90785 has been added to designate "interactive complexity" when communication factors may complicate delivery of a psychiatric procedure.

"The APA is aware that some psychiatrists have contracts with payers that limit the codes they will be reimbursed for to those in the Psychiatry section of the CPT," said the organization in a statement.

"We will be doing outreach to major payers to ensure that they are aware the codes are changing and will be making the necessary accommodations." They add that clinicians should also contact their payers.

In addition, they report that the CMS has "a well written guide" on E/M coding for all physicians posted on their Web site. The guideline sections pertaining just to psychiatrists are also posted on the APA Web site under the "APA Coding Resources for Members" subhead.

Psychiatrists' Next Steps

"I predict that these changes will be most striking for psychiatrists who have principally worked in a variety of settings," said Dr. Burd.

"Also, there are big changes in the psychotherapy with E/M codes. That's why doctors really need to learn the E/M documentation."

Resources regarding the upcoming CPT code changes can be found on both the AACAP and APA Web sites. Information on registering for the next Webinar by the National Council is available on their Web site.

The AMA's 2013 edition of the full 690-page CPT manual, in softbound and ebook formats, can also be purchased at the organization's online bookstore.

Dr. Burd reported that the APA is also working to provide an expert on the CPT changes for each state and hopes to provide several upcoming Webinars, including one on coding in academic settings and one on what to use instead of the soon-to-be deleted 90862 code.

"That code has been used in so many ways and in so many places that, depending on the setting, there are going to be a lot of different options that people need to be aware of," he said.

In a year that will also see the introduction of the new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), 2013 will be "the start of a new era," said Dr. Musher.

"When this kind of major change comes out, and it directly affects how people will be paid for their work, it's not surprising that people are very interested and want to get it right. Psychiatrists need to look at the type of work they do and where. Then, look at the new codes to figure out which ones you're more likely to be using and familiarize yourself with them," he said.

"Overall, I think it's getting a bit of exposure and some practice. My perception is that 90% of this is not that hard. The hard part is that 10% of the edges. It's figuring out: what do I do when? It's the specifics," added Dr. Burd.

"So let us know if you have questions, use the Web sites, contact your state associations, and don't give up. We're hoping that these changes will be more accurate. And psychiatrists will be able to get better reimbursed for the work they do."

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