2013 CPT Coding Changes Psychiatry

Transcription

1 2013 CPT Coding Changes Psychiatry CPT made dramatic changes to this coding section to better reflect the different work performed by physicians and other healthcare professionals and to capture changes in the way psychotherapy services are provided since the inception of the psychiatry codes to CPT in Deleted Codes as of 2013 Office or Other Outpatient Facility Insight Oriented, Behavior Modifying &/or Supportive Psychotherapy Interactive Psychotherapy Inpatient Hospital, Partial Hospital or Residential Care Facility Insight Oriented, Behavior Modifying &/or Supportive Psychotherapy Interactive Psychotherapy Other Psychotherapy Psychiatric Services or Procedures Interactive Group Psychotherapy Pharmacologic Management New Codes as of 2013 & Coding Policies Services may be provided to a patient in crisis. Services are provided in all settings of care. Codes are no longer reported based on a specific setting (eg office, hospital, etc.) Some psychiatry services may be reported with Evaluation & Management (E/M) codes, , , , New section and code for Interactive Complexity A Interactive complexity (List separately in addition to the code for primary procedure) Code is an add-on code for interactive complexity to be reported in conjunction with codes for diagnostic psychiatric evaluation ( ) psychotherapy (90832, 90834, 90837), psychotherapy when performed with EM services (90833, 90836, 90838, , , ), and group psychotherapy (90853). Do not report in conjunction with (Psychotherapy for crisis) or in conjunction with E/M services when NO psychotherapy service is also reported. Physicians First, Inc Lake Pointe Drive, #708 Orlando, Florida Phone (407) Fax (407) [email protected]

2 B. What is Interactive Complexity Per CPT 2013:..refers to specific communication factors that complicate the delivery of a psychiatric procedure. Common factors include more difficult communication with discordant or emotional family members and engagement of young and verbally underdeveloped or impaired patients. Typical patients are those who have third parties, such as parents, guardians, other family members, interpreters, language translators, agencies, court officers, or school involved in their psychiatric care. These are the factors typically present with patients who: Have other individuals legally responsible for their care, such as minors or adults with guardians, or Request others to be involved in their care during the visit, such as adults accompanied by one or more participating family members or interpreter or language translator, or Require the involvement of other third parties such as child welfare agencies, parole or probation officers, or schools. Psychiatric procedures may be reported with interactive complexity when AT LEAST ONE of the following is present: Please insure documentation supports the medical necessity for the interactive complexity 1. The need to manage maladaptive communication (related to, eg high anxiety, high reactivity, repeated questions, or disagreement) among participants that complicates delivery of care. 2. Caregiver emotions or behavior that interferes with the caregiver s understanding and ability to assist in the implementation of the treatment plan. 3. Evidence of disclosure of sentinel event and mandated report to 3rd party (eg abuse or neglect with report to a state agency) with initiation of discussion of the sentinel event and/or report with patient and other visit participants. 4. Use of play equipment, other physical devices, interpreter, or translator to communicate with the patient to overcome barriers to therapeutic or diagnostic interaction between the physician or other qualified health care professionals and a patient who: Is not fluent in the same language as the provider, or Has not developed, or has lost, either the expressive language communication skills to explain his/her symptoms and response to treatment, or the receptive communication skills to understand the provider if he/she were to use typical language for communication. NOTE: CMS included language in the 2013 Medicare final rules indicating should not be billed solely for the purpose of translation or interpretation services. Federal laws prohibit discrimination, which in this case would take the form of higher beneficiary payments and copayments for the same service, based on disability or ethnicity. Billing for this service solely for translation or interpretation related to a beneficiary s disability could implicate section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Page 2 of 6

3 Act, and billing for this service solely for translation or interpretation related to foreign language could implicate Title VI of the Civil Rights Act of C. When interactive complexity is provided in conjunction with the new psychotherapy services ( ), the amount of time spent by the provider should be reflected in the timed service code for psychotherapy (90832, 90834, 90837) or the add on codes for psychotherapy performed with evaluation and management 90833, 90836, 90838). D. DO NOT report interactive complexity with E/M codes when NO psychotherapy service is reported. E. DO NOT report interactive complexity in conjunction with the new Psychotherapy for Crisis codes, 90839, Psychiatric Diagnostic Procedures A. New Codes Psychiatric diagnostic evaluation Psychiatric diagnostic evaluation with medical services (the medical services piece includes elements of E/M services such as review of systems, exam, prescription of medications) B is: an integrated biopsychological assessment including history, mental status, and recommendations. The evaluation may include communication with family or other sources and review and ordering of diagnostic studies. C is:...an integrated biopsychological assessment and medical assessment, including history, mental status, other physical exam elements, as indicated and recommendations. The evaluation may include communication with family or other sources, prescription of medications, and review and ordering of laboratory or other diagnostic studies. D. The service is provided to the patient and NOT to other informants such as family members, guardians, or significant others. E. The codes are reported once per day and NOT on the same day as an evaluation and management (E/M) service performed by the same provider for the same patient. Do not report 90791/90792 in conjunction with , , , (These are all E/M codes). F. Interactive complexity (90785) MAY be billed on the same day when factors complicate the delivery of the 90791/ Be sure to document the medical necessity of the interactive complexity. Use in conjunction with 90791/90792 when supported Page 3 of 6

4 G. Psychotherapy services, including for crisis, MAY NOT be reported on the same day. 3. Psychotherapy These are time based codes Be sure to document time in your notes A. New Codes Psychotherapy, 30 minutes with patient and/or family member Add on Code Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service (List separately in addition to the code for primary procedure) THE PRIMARY PROCEDURE WOULD BE THE E/M CODE Used in conjunction with , , Psychotherapy, 45 minutes with patient and/or family member Add on Code Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service (List separately in addition to the code for primary procedure) Use in conjunction with , , Psychotherapy, 60 minutes with patient and/or family member Add on Code Psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service (List separately in addition to the code for primary procedure) Use in conjunction with , , B. Choose the code closest to the actual time: For and minutes For and minutes For and or more minutes Less than 16 minutes may NOT be reported using the psychotherapy codes. C. Psychotherapy times are for face to face service with the patient and/or family member. The patient MUST be present for some or all of the service. For family psychotherapy WITHOUT the patient present use code D. To report E/M with Psychotherapy, the 2 services MUST be separate and identifiable. The E/M service MUST be documented according to E/M documentation guidelines (History, Exam, and Decision Making). The time spent performing the E/M service MAY NOT be applied to the time for the psychotherapy. You MAY NOT choose the level of service for the E/M service based on the greater than 50% rule for counseling and coordination of care. Page 4 of 6

5 E. Psychotherapy Codes MAY NOT be billed on the same day as Psychotherapy in Crisis codes (90839 and 90840) 4. Psychotherapy in Crisis These are time based codes so time spent must be documented in the record A. New Codes Psychotherapy for crisis; first 60 minutes First minutes per CPT guidelines For less than 30 minutes see or (Add-on code) Psychotherapy for crisis; each additional 30 minutes (List separately in addition to code or primary service) Each 30 minutes above initial 74 minutes per CPT Do not report 90839/90840 in conjunction with 90791/90792, , If the time spent in psychotherapy in crisis is less than 30 minutes, DO NOT report Instead you would report or (when E/M is included). B. Defining Crisis Per CPT: Psychotherapy for crisis is an URGENT assessment and history of a crisis state, a mental status exam, and a disposition. The treatment includes psychotherapy, mobilization of resources to defuse the crisis and restore safety, and implementation of psychotherapeutic interventions to minimize the potential for psychological trauma. The presenting problem is typically life threatening or complex and requires immediate attention to a patient in high distress. C. The time reported is based on face to face time with the patient and/or family on a given date even if the time is not continuous. During the time counted for psychotherapy in crisis the provider MUST be devoting their full attention to the patient and MAY NOT provide services to any other patient. The patient must be present for some or all of the service. NOTE: Relative values for these two codes HAVE NOT been assigned. The codes are carrier priced for Medicare. 5. New Pharmacologic Management - status I not paid by Medicare One of the biggest changes in 2013 and perhaps the most disappointing for providers (Add-on code) Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services (List separately in addition to the code for primary procedure) Page 5 of 6

6 Use in conjunction with 90832, 90834, For pharmacologic management with psychotherapy services performed by a physician or other qualified health care professionals who may report EM codes, use the appropriate EM codes , , , and the appropriate psychotherapy with EM service 90833, 90836, A. Psychiatrists MAY NOT use as prescription drug management is included in an E/M service. B. Any Non-Physician Practitioner who is authorized to report E/M codes WILL NOT be allowed to bill using C. CPT created the code to allow qualified healthcare professionals who ARE NOT authorized to report E/M services to bill for pharmacologic management when performed with psychotherapy. CMS has taken the stance that clinical psychologists ARE NOT allowed to use the code as the description, medical psychotherapy implies the service is an E/M service. Even if the description of medical psychotherapy was altered, CMS still would not change their position as they believe pharmacologic management services require some knowledge and ability to perform E/M services. FOR THIS REASON FOR 2013 MEDICARE HAS ASSIGNED A STATUS OF I TO THIS CODE NOT VALID FOR MEDICARE PURPOSES 6. Revised Codes-SPECIFIC TIMES now applied to 90876, Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 30 minutes Prior to 2013 the code was minutes Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); 45 minutes Prior to 2013 the code was minutes Physicians First, Inc. documents are designed to provide reliable and authoritative information, and every reasonable effort has been made to insure the accuracy of the information contained herein. The company assumes no legal responsibility for the use or misuse of the contents of this document. Page 6 of 6