2013 Psychiatric CPT Code Update
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1 2013 Psychiatric CPT Code Update APNA Webinar December 7, 2012 Sandra J. Cadena I have no conflict of interest or commercial support to disclose. Objectives Describe the 2013 revisions to the Current Procedural Terminology (CPT) codes related to psychiatric billing and documentation Compare and contrast the new CPT and existing codes for billing and documentation purposes in PMH nursing practice 1
2 Categories of CPT Codes Diagnostic Psychotherapy Psychotherapy with E/M Other Psychotherapy Other Psychiatric Services Diagnostic Codes 2012 Service CPT Code 2013 Change Diagnostic interview examination DELETED Interactive diagnostic interview examination DELETED 2
3 Diagnostic Codes 2013 Service Code Report with interactive complexity (+90785) Diagnostic evaluation (no medical) Diagnostic evaluation with medical Diagnostic evaluation (no medical) Diagnostic evaluation with medical WHEN APPROPRIATE WHEN APPROPRIATE YES YES Psychotherapy Codes Service CPT Code 2013 Change Individual psychotherapy minutes 90804, minutes 90806, DELETED minutes 90808, Interactive individual psychotherapy minutes 90810, DELETED minutes 90812, minutes 90814,
4 Psychotherapy Codes 2013 Changes Service Psychotherapy 30 minutes (16 to 37 minutes) CPT Code Change Report with Interactive complexity (+90785) 45 minutes (38 to 52 minutes) 60 minutes (53+ minutes) When appropirate Psychotherapy Codes 2013 Changes Service Interactive Psychotherapy 30 minutes (16 to 37 minutes) CPT Code Change Yes Report with Interactive complexity (+90785) 45 minutes (38 to 52 minutes) 60 minutes (53+ minutes) Yes Yes 4
5 Psychotherapy with Evaluation & Management (E/M) Codes Service CPT Code 2013 Change Individual psychotherapy with E/M minutes 90805, minutes 90807, DELETED minutes 90809, Interactive individual psychotherapy minutes 90811, DELETED minutes 90813, minutes 90815, Psychotherapy with Evaluation & Management (E/M) Codes Service Code Report with interactive complexity (+90785) E/M plus psychotherapy add-on E/M code (selected using key components, not time) and one of: (16-37*) minutes (38-52*) minutes (53+*) minutes When appropriate Yes 5
6 Other Psychotherapy Codes Service CPT Code 2013 Change Family psychotherapy Group psychotherapy Interactive group psychotherapy 90846, 90847, RETAINED RETAINED DELETED Other Psychotherapy Codes Service CPT Code Report with interactive complexity (+90785) Psychotherapy for crisis Family psychotherapy Group psychotherapy Interactive group psychotherapy 90839, , 90847, NO NO When appropriate Yes 6
7 Other Psychiatric Services Service Code 2013 Change Pharmacologic management DELETED Other Psychiatric Services Service Code Report with interactive complexity (+90785) Evaluation and E/M code No management CPT five-digit codes, descriptions, and other data only are copyright 2011 by the American Medical Association (AMA). All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. CPT is a registered trademark of the American Medical Association (AMA). 7
8 E/M and Psychotherapy Coding Algorithm-Step 1 E/M E/M Alone E/M Plus Psychotherapy Step 1: Select E/M Code Outpatient : 99204,05,13,14,15 Inpatient: 99222,23,31,32,33 Step 2: Select Psychotherapy Time 8
9 E/M Plus Psychotherapy Reporting Psychotherapy Time Report Code 30 (16-37*) minutes E/M Code and (38-52*) minutes E/M Code and (53+*) minutes E/M Code and * CPT Time Rule E/M and Psychotherapy Coding Algorithm-Step 2 Psychotherapy Psychoanalysis Psychotherapy Family Therapy Time: 30, 45, 60 minutes Pt not present, present, group 9
10 Psychotherapy Reporting Psychotherapy Time Report Code 30 (16-37*) minutes (38-52*) minutes (53+*) minutes Family Psychotherapy Reporting 10
11 E/M and Psychotherapy Coding Algorithm-Step 3 Psychotherapy Group Therapy Psychotherapy for Crisis Time: 30-74, +30 minutes Psychotherapy for Crisis Reporting Psychotherapy Time minutes Report Code +30 minutes
12 Interactive Complexity Present Psychotherapy Time Report Code 30 (16-37*) minutes E/M Code, and (38-52*) minutes E/M Code, and (53+*) minutes E/M Code, and Interactive Complexity Present Psychotherapy Time Report Code 30 (16-37*) minutes and (38-52*) minutes and (53+*) minutes and
13 Interactive Complexity Present Group Therapy Report Code and Interactive Complexity A new concept in 2013 Refers to 4 specific communication factors during a visit Complicate delivery of the primary psychiatric procedure Report with CPT add-on code
14 4 Communication Factors that Complicate Psychotherapy Visits 1. The need to manage maladaptive communication (related to, e.g., high anxiety, high reactivity, repeated questions, or disagreement) among participants that complicates delivery of care. 2. Caregiver emotions or behaviors that interfere with implementation of the treatment plan. 14
15 3. Evidence or disclosure of a sentinel event and mandated report to a third party (e.g., abuse or neglect with report to state agency) with initiation of discussion of the sentinel event and/or report with patient and other visit participants. 4. Use of play equipment, physical devices, interpreter or translator to overcome barriers to diagnostic or therapeutic interaction with a patient who is not fluent in the same language or who has not developed or lost expressive or receptive language skills to use or understand typical language. 15
16 Interactive complexity is an Add-on Code Need only 1 communication factor when seeing a patient Add-on codes may be reported in conjunction with specified "primary procedure codes. Add-on codes may never be reported alone. Psychiatric primary procedures and Codes Psychiatric diagnostic evaluation, 90791, Psychotherapy, 90832, 90834, Psychotherapy add-on codes, 90833, 90836, 90838, when reported with E/M Group psychotherapy,
17 Interactive Complexity Code (90875) Should Not be Used with: Psychotherapy for crisis (90839, 90840) E/M alone, i.e., E/M service not reported in conjunction with a psychotherapy add-on service Family psychotherapy (90846, , 90849) Interactive Complexity and Time When performed with psychotherapy, interactive complexity (90785) relates only to the increased work intensity Does not change the time for the psychotherapy service. 17
18 Final Notes 2013 CPT changes more adequately reflect the complexity in actual practice APNs continue to diagnose and treat patients with comorbidities and complicated histories Treatment entails increased coordination of care, involving other providers, social organizations and family members. References 2013 CPT Coding Manual American Academy of Children and Adolescent Psychiatry (AACAP) online webinars permission granted to APNA American Psychiatric Association: Medicare learning network: Education/Medicare-Learning-Network- MLN/MLNProducts/downloads/eval_mgmt_serv_guide -ICN pdf 18
19 Thank you! We hope that you find the information helpful and uncomplicate the new CPT codes. We believe that these changes provide addtional options to code services, directly reflecting the level of complex care APNs provide. Sandra J. Cadena, PhD, APRN, PMHCNS-BC, CNE 19
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