Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Monday, May 13, 2013

CPT-New and Improved?

In response to my recent CPT article, CPT: A Primer, in The Carlat Report, I received an email from Joel Shield, MD. I don't know Dr. Shield, but I want to share some of the content, and I have his permission to do so.

Dr. Shield writes about the real CPT coding, as opposed to what's being presented as CPT coding, which is really the Center for Medicare Services' (CMS) version, the version I've researched and written about because I didn't realize there was a difference.

What is the difference? Basically, the CMS version is a checklist, with, for example, 1-3 elements of HPI, at least 6 elements on exam, and 1 pertinent ROS for a 99213 (see my post).

But the version from the CPT 2013 manual is much more descriptive. You have to meet the same standard-providing enough information to qualify your coding, but it's much less of a checklist.

I'm not getting into too much detail because that might involve purchasing the manual so I could figure out what goes into it. Dr. Shield forwarded two articles he wrote up about the coding, and I'd like to include them, but I haven't figured out how to attach a pdf to a post. If anyone knows, by the way, please comment and tell me how.

However, a nice summary was included with the email I received:

In summary, the CPT manual and the CMS guidelines use the same categories for coding E&M services (the four levels of history, examination, and medical decision making), but differ significantly in some of the details of those categories (for example, the CMS guidelines specifying psychiatric, constitutional, and musculoskeletal parts of the psychiatric examination) and, most importantly, in adding a sub-basement level of very detailed requirements for what defines the levels of history, examination, and medical decision making. While the descriptions of the levels in the CPT manual are, in general terms, the same as those of CMS, because they are more descriptive they can be satisfied more flexibly and more easily. 

Now here's the rub: If you document more descriptively, you can be less freaked out about what goes into your documentation. You might even be able to write the kind of note you're accustomed to, one that has something to do with patient care. But, if you ever get audited, or need to justify your services to someone who may or may not have graduated from high school, someone who is simply going to count the number of bullet points you did or didn't include in your documentation, then you're better off having bullet points to be counted.

To be honest, I'm bugging out a little over all the recent changes. You need to bill differently, and learn how to bill differently. You need to diagnose differently, and learn how to diagnose differently. It's too much. I'd really like to get back to my day job.

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