Changes to Psychiatry CPT Codes

Getting Ready for 2013

 

Background

Almost all of the codes in the Psychiatry section of CPT (the 908xx series of codes) will be changing next year.  We are not permitted to provide specific information about the new CPT codes that will be used for psychiatry services beginning in 2013 until they are published by the AMA this fall. However, starting right now, there are a number of things a practice can do to prepare for the code changes that will help you be ready when the new codes go into use.  

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 CPT. 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 so there will not be a hold-up with reimbursement when the new codes go into effect.  

Practical Steps

The one specific we are able to provide about the changes is that code 90862, pharmacologic management, will no longer exist in 2013. Even now, it is appropriate to use a medical evaluation and management (E/M) code (i.e., 99212 or 99213) in place of 90862.)   

Start familiarizing yourself with E/M codes for medication management and other patient encounters that are not  primarily for psychotherapy. Unlike the psychotherapy codes, which are almost all timed codes, E/M codes are generally chosen based on the complexity of the presenting problem, the intensity of the examination required, and the difficulty of the medical decision making involved (as well as the setting where the service takes place and whether the patient is new or established). There are, however, typical times attached to the codes, and coding can be based on time if more than half of the patient encounter was spent in counseling the patient and providing coordination of care.   

The Centers for Medicare and Medicaid Services (CMS) has a well written guide to E/M coding available on its website along with two sets of documentation guidelines for E/M coding – one from 1995 and the other from 1997. These guidelines are used by most payers when auditing E/M coding. The 1997 guidelines are the most appropriate ones for psychiatrists to use since they include a single-system psychiatric exam.  We have posted an abridged version of the 1997 documentation guidelines (scroll to CMS Resources) on the APA website that just contains the information relevant to psychiatrists.  The APA also has an online CME course that provides an introduction to E/M coding at www.apaeducation.org.  

Contracts
You should review any contracts you have with insurers to see if they limit you to  the current codes in the Psychiatry section of CPT (most of which will no longer exist in 2013).  The APA will be contacting the major payers to alert them to the code changes, but it  would also make sense for you to contact them to  inquire about what will be done to revise the contract to accommodate the coding changes.  Under HIPAA (the Health Insurance Portability and Accountability Act) all insurers are required to use the current CPT codes, which means they will be required to use the new coding schema and will need to update any contracts to take into account the new codes that psychiatrists will be using and also to ensure that psychiatrists will be reimbursed for providing evaluation and management services as the Parity Act requires.   

Conclusion

Since there may only be three months between when the new psychiatry CPT codes are made public and when they will go into effect, it’s good to be doing everything you can to prepare for the changes now.  Keep watching the APA website for new information and contact the Practice Management HelpLine—800.343.4671, hsf@psych.org —if you have any questions.

LEARN MORE on the 2013 CHANGES