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2013 Psychiatry and Psychotherapy CPT Code Changes
There are significant changes for CPT coding of psychiatric services beginning January 1, 2013. The AMA conducted a comprehensive review of the psychiatry CPT codes and created new codes as well as a new coding methodology to more accurately reflect current psychiatric practice. ICANotes has developed resources to help mental health clinicians prepare for the change.
White Paper (describes how to replace 90862 with an E/M Code)
Video Overview of the CPT Code Changes:
Summary of the 2013 Psychiatry and Psychotherapy CPT Code Changes
This video describes the changes that are coming to CPT codes for psychiatry and psychotherapy in 2013. It also provides a brief demonstration of an innovative software program that tracks coding credit for each required E/M coding documentation element and automatically arrives that the highest reimbursable E/M code supported by each note. ICANotes users achieve higher reimbursement for E/M services while eliminating the risk of rejection by surveyors and costly paybacks. No more worries about over-coding or under-coding for services performed.
On January 1, the stalwart of mental health coding, 90862 for pharmacologic management, is being discontinued and replaced with E/M codes. This change has some advantages and disadvantages: clinicians can now get paid more for complicated cases, but they will need to document in a more detailed fashion.
The CPT code 90862 paid the same fee regardless of the complexity of the case. The good news is that E/M codes pay higher fees for moderate and highly complex cases. Regardless of the complexity of the case, if you document thoroughly enough, you can achieve a moderate level of complexity which will pay more than the 90862 reimbursement rate. 90862 paid $50.49 and a 99214 E/M code for a moderately complex case pays $84.29.
The disadvantage of E/M coding is that the documentation requirements are complicated. It is not sufficient just to do a thorough mental status exam. You must document in your note up to 11 specific elements. There are similar requirements for history, and you must also state why the case is the level of complexity you are coding. It’s a lot to track in your mind to achieve the desired coding level. In addition, the documentation requirements change depending on where you are working.
In the past, the complexity of the documentation requirements turned many clinicians away from E/M codes. Although 90862 didn’t pay as much, you didn’t have to keep as detailed track of your documentation. With the advent of EMRs, however, a number of programs keep track for you. In ICANotes, the program tracks the elements you document in the MSE and the History to arrive at the highest reimbursable E/M code supported by your note.
The second major change is that 90801 (Psychiatric Diagnostic Interview) has been eliminated and split into two new codes, one for non-prescribers and one for prescribers, 90791 and 90792 respectively. Both codes can be billed on the same day, so your intake worker can do a diagnostic interview, the prescriber can do one, and they can both be billed.
The third significant change affects non-prescribers and prescribers who bill for a combination of psychotherapy and E/M services. 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)
These codes are being simplified and replaced by just 3 psychotherapy alone codes (no E/M services). It doesn’t matter what setting you are in, the codes are entirely dependent on time spent with the patient and/or the patient’s family. This is new as in the past psychotherapy time counted only time spent with the patient. The new codes are as follows:
- 90832 30'' (16''-37'')
- 90834 45'' (38''-52'')
- 90837 60'' (53''+ )
What about Psychotherapy with E/M Services? They have been unlinked. You can bill for the E/M service and you can bill for the amount of face time spent with patient and/or family using an add-on psychotherapy code:
- +90833 30'' (16''-37'')
- +90836 45'' (38''-52'')
- +90838 60'' (53''+ )
This is also good news because the combined CPT code did not take complexity into consideration. Now you can bill first the E/M code adjusted for complexity and you still bill for psychotherapy based on time as an add-on. You will be submitting two numbers.
If you’ve done psychotherapy (prescribers and non-prescribers) for a particularly complex case, you get credit for the complexity. A third code can be used, interactive complexity add-on 90785. You will use it when doing play therapy, when communications problems exist, where there is a maladaptive situation that complicates therapy, or when caretaker problems complicate treatment, or when there is a sentinel event. All of these reasons need to be documented in your note to support use of the code.
Finally, a Patient In Crisis add-on code, also time related, can be used when the presenting problem is life threatening or complex and requires immediate attention to a patient in high distress. This add-on is only for non-prescribers:
- +90839 60 minutes (53'' -74'')
- +90840 each additional 30''