Over the CPT Cliff: How Far the Fall?

Ten days into the new coding year in psychiatry I still read chaos among physicians and other providers attempting to get it right. Some say many already have it down, but in forum and listserve alike others still struggle, especially it seems around questions of coding of psychotherapy combined with medical management. How long before we hit bottom and the dust settles?

Code too low, and your insured patient may complain that you have not obtained the reimbursement they deserve, too high and the payer may accuse you of fraudulent billing after reviewing your records. On which side should you err? How much time and effort do you expend attempting to do what the patient's illness requires and assure that your documentation justifies your claim? What templates minimize the time required, and how do you leave some time for actually treating the patient?

Remember the patient?

Some predict that at last payers will compensate psychiatrists fairly for treating complex patients. Others predict that even more psychiatrists will move to ever shorter "med checks," neglecting their relationship with the patient in favor of more elaborate templates, unnecessary data collection, and meangless check sheets. Should we naively assume that the payers will open their wallets to us, yielding a reimbursement windfall? Somehow I doubt it.

I believe payers will exploit the real or apparent chaos of the initial wave of claims with new codes to delay payments for months -- if not years. It will take at least a year for payers to accumulate stable claim data, after which they will adjust reimbursement as they wish to maximize profit or minimize premiums. Remember too that by state and federal law payers can demand refund of payments for as long as seven years if they determine they paid in error. If you still accept payments from payers what better time to stop and let the patient take the risk? Charge a fair fee your patients can afford at the time of service, document well, claim conservatively, and keep your priority clinical rather than financial. Do you want those online reviews to rave about your success at getting money for the patient or your success at treating their mental illness?

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