CPT Coding Changes-Big Things Are Happening

Toto, dude! We're totally not in Kansas anymore.

On January 1st, 2013, CPT coding will change for psychiatry. Here's the scoop:

The codes we're used to, 90801, 90807, 90806, 90805, 90862, will no longer exist . The rationale is that they're trying to get MD's to code differently from psychologists or social workers. Something to do with parity (not parody).

An initial eval will be 90792 instead of 90801. Other types of sessions will need both a CPT or procedure code, and an Evaluation & Management (E/M) code. In other words, there's one code, the E/M, for how you figured out what needed to be done, and another code, the CPT, for what you actually did. I don't think the E/M requirement applies to group/couples/or family therapy, though. Also, I may be confused about the initial eval not requiring an additional E/M code

The CPT code is for psychotherapy, which is considered a procedure. There are 3 such codes:

90833- for 30 minute sessions
90836- for 45 minute sessions
90838- for 60 minute sessions

There are no longer time ranges for sessions (e.g. 90807 was 45-50 minutes)

These are face-to-face times, and there are minimum times to code for each:

At least 16 minutes of psychotherapy time for a 90833, 38 minutes for a 90836, and 53 minutes for a 90838. This is not as confusing as it looks. 16 is 1 more minute than half of 30, 38 is the first whole number greater than 37.5, the midway point between 30 and 45, and the same for 53 between 45 and 60. In other words, at least half.

But the implications are problematic. For example, if your patient arrives 20 minutes late for a 45 minute session, you can only bill for a 30 minute session. You can agree with your patient that he will need to pay the full fee for the amount of time you set aside, even if he's late, but if you accept assignment, you can't do that.

And if you want to charge your patient for missed sessions, you have to have an agreement in writing beforehand.

Which E/M code you add on to the CPT codes has to do with the level of complexity of the patient/session, and there are 4 such levels, numbered 99212 through 99215, although 99215 is complicated enough that you'll probably never be able to code for it. There are requirements for documentation at each level, with 99212 having the fewest requirements.

There are three components to what determines the E/M level: History, Examination, and Medical Decision Making. Naturally, the more complex the session, the greater the reimbursement, so it's important to document appropriately so you can bill for the highest possible level.

In my next post, I'll go into detail about how this works, and I'll include examples of notes that document different levels of care.