Prepare for the Coding Cliff

Meeting with a bunch of psychotherapists in my building the other day I asked how they planned to prepare for the changes in Current Procedural Terminology (CPT) codes scheduled to take effect on January 1. (CPT codes allow payers to reimburse for medical claims based on a numerical code.) None of them acknowledged any awareness of the change and its likely impact.

CPT codes have become one of the few remaining reasons for existence of the American Medical Association, which profits considerably from their publication, still a monopoly despite the fact that only a small minority of physicians still belong. Do not expect AMA to help you unless you belong. They make money selling the information you need.

I understand that new codes will replace all the old psychiatric codes, including initial evaluation, psychotherapy, and medical management. Do not expect payers to help you. If you submit an outdated code, they get to delay payment.

Psychotherapists may have it relatively easy. Just figure out what new codes replace the old codes.

Psychiatrists who provide what we used to call medical management will, however, start to use the same evaluation and management (E/M) codes internists and other primary care physicians have used for years. More complex than psychotherapy coding, each level of "procedure" requires performance of different services. For example, you may expect a sudden explosion in psychiatrists checking vital signs (pulse, blood pressure, etc.) at every encounter with patients who somehow survived all those past years without.

The devil may be in the documentation. Someday a payer may audit your records and have you sent to jail for fraud if your notes fail to support the procedure you claimed.

The American Psychiatric Association seems all excited at the prospect of psychiatrists obtaining reimbursement more commensurate with services provided. I will believe that when I see it. Do not expect APA to help unless you belong. APA retains few other benefits of membership. Notice I wrote reimbursement, not payment. This change means nothing to patients who pay you directly for your services. Do not expect them to jump for joy at the prospect of paying you more for the same service so your insured patients get better reimbursement. Ask them how much they want to pay for you to check blood pressure on every visit. Will we risk breaking some law if we continue to bill cash patients the old fashioned way while claiming new codes for those insured? Possibly.

How to prepare: I plan to look for online courses, ask my internist friends, and borrow a copy of one of the coding manuals published by AMA from a library. Good luck. Stay out of jail: only code for what you actually did.

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