CPT Code Changes OptumHealth New Mexico

Transcription

1 CPT Code Changes 2013 OptumHealth New Mexico 1

2 CPT Defined CPT codes are five-digit numeric codes used by providers for billing purposes to describe the type of service provided these are NOT diagnostic codes. The last major revision to the Psychiatry family of codes occurred in Implementation on January 1st, 2013 All mental health professionals including psychologists, counselors, psychiatrists, nurses and social workers delivering psychotherapy services will use the same new codes. (National Council for Community Behavioral Healthcare) UHG documentation and online presentations may contain different information than that of New Mexico specifications. 2

3 AMA Rationale for Change Evidence of dramatic changes in the practice of psychiatry/mental health since 1998 Increased intensity of services increase in co-morbidities shift from inpatient to outpatient settings Current coding structure doesn t allow for accurate description of varying levels of medical management and psychotherapy Interactive psychotherapy determined to be too narrowly defined to allow for accurate description related to intensity of services provided, regardless of length of session time Current coding structure doesn t allow for accurate description of crisis services 3

4 4

5 Fee Schedule Explanation The new fee schedules will list service codes with licensure levels and funding sources available. In order to keep Medicaid funding budget neutral some of the add on codes will NOT have a rate listed on the fee schedule. This is denoted with a N/A or $0 Example: (Interactive Complexity Code) = $0 If is billed by itself = standard group therapy If is billed with = indicates group therapy with an interactive component Please consult your fee schedule. 5

6 Diagnostic Codes Retiring and Psychiatric diagnostic evaluation (without medical services): Psychiatric diagnostic evaluation with medical services:

7 Psychotherapy Codes CPT codes 90804, 90806, 90808, 90810, 90812, and have been retired. Codes have been replaced with minutes minutes minutes Time is chosen according to the CPT time rule For up to 37 minutes, the 30 minute code would be used For minutes, 45 minute code would be used For 53+ minutes, 60 minute code would be used Psychotherapy less than 16 minutes is not reported Psychotherapy codes are no longer site specific but can apply to any place of service Psychotherapy time now includes face-to-face time spent the patient and/or family member 7

8 Pharmacological Management Retiring For non-md s: is an add-on code to be reported only in conjunction with psychotherapy codes 90832, 90834, and For MD s (psychiatrist): Use appropriate E/M code for pharmacologic management when both psychotherapy and E/M is provided (99xxx and 90832). If providing only pharmacological management, report only E/M service code. Refer to specific provider fee schedules for appropriate code and licensure levels 8

9 New Code - Interactive Complexity A new code has been created to document interactive complexity. It denotes greater interaction or work intensity (complexity) during the assessment, evaluation or psychotherapy session. This is an add on code and can be used with: Diagnostic evaluations (90791 without medical & with medical) Psychotherapy (90832, 90834, 90837) Psychotherapy when performed with E/M service (+90833, , , , , ) Group Psychotherapy (90853) is budget neutral code priced at $0.00 9

10 Learn about Evaluation and Management (E/M) Codes Evaluation and Management or E/M Codes (99XXX) Consult your fee schedule to determine which E/M codes (if any) you can bill for. Be aware of: Licensure levels Specific CPT Codes to use in conjunction with E/M Learn more about E/M codes at: Learning-Network- MLN/MLNProducts/downloads/referenceII.pdf 10

11 How do I bill that? OHNM Provider Portal our online secure transaction feature will be ready to receive 2013 CPT codes on January 1, 2013 EDI Clearinghouse/Vendors talk directly with your clearinghouse and software vendor regarding system readiness Paper claims use CMS 1500 form, section 24 E/M Codes determine the appropriate E/M code based on factors such as patient history, exam or medical decision-making or based on time E/M codes start with 99 Remaining digits reflect information about such factors as level of medical decision-making involved 11

12 Billing Example Psychiatrists formerly billing 90805: minutes, individual psychotherapy with evaluation and management Follow appropriate decision-tree to enter the correct E/M code Enter add on code with same information to reflect 30 minutes Interactive Diagnostic Evaluation no Medical 12

13 What is Optum Doing to Prepare Systems / Technology Claims OHNM Provider Portal Clinical Reporting Communications Provider Alerts, Announcements and Training Opportunities Notice of Amendment with Fee Schedules Auto-dialer phone messaging/phone Calls OHNM Provider Portal User Group Webinars from UnitedHealth Group will offer playback Internal Education/Support Contracting/Provider Relations Specialists Coordination with all other departments 13

14 More Information Provider Relation Specialists Jeff Daninger Cindy Morgan The National Council Webinars Audio recordings or printed presentations CPT Code Changes for 2013: Impact on Behavioral Health Jeremy Musher, David R. Swann, and Adam Falcone, November 9, 2012 E/M 101: Preparing Your Organization for 2013 CPT Code Changes David R. Swann,Yanick Hazlewood, and Adam Falcone, December 3, 2012 American Psychological Association Billing & Coding information focused on Psychologists but valuable to other disciplines as well American Psychiatric Association Public and Member only materials Publicly accessible crosswalks, APA/AACAP Code Crosswalk, E/M summary guides and more 14

15 Questions For More Information Please Contact: option 4 then 6 15