Will Vital Signs Pad the Psychotherapy Bill?

What I detect from many psychiatrists writing in online forums about their plans for coping with coding in the new year seems to confirm my prediction here: Psychiatrists providing psychotherapy will suddenly find it necessary to measure and record vital signs, such as pulse, blood pressure, respiratory rate and weight as part of the "procedure" in order to maximize reimbursement. Submitting a claim to a payer coding for psychotherapy alone will result in paltry reimbursement, but adding an E/M CPT code that requires documentation of vital signs may substantially pad that bill.
Suppose your psychiatrist charges $200 for full session (nominally 50 minutes) psychotherapy. On  January 1 reimbursement for the new code will likely plummet, but by adding the E/M code, which requires documentation of vital signs, the payers may cough up considerably more money. Insured patients will like this after they have satisfied their deductibles, but until then they must pay more. How much do you want to pay to have your vital signs checked every session, especially considering the corresponding reduction in psychotherapy time? 
Maybe vital signs will become grist for the psychotherapy mill: 
"How do you feel about that blood pressure reading?"
"Your heart seems to be racing today. Are you excited to see me, or just worried about how you much you will have to pay for me to check your pulse?"
Maybe some psychiatrists will try to minimize the patients' financial burden until the deductible has been satisfied:
"Mr. Jones I see you have satisfied your deductible, we had better start checking your weight at the start of every session. But don't worry, we can stop at the end of the year."
I predict psychiatrists will somehow continue to manage to treat uninsured patients without checking their vital signs.
Some see the CPT change as moving psychiatry closer to the rest of medicine. I see it separating psychiatrists with integrity from those without. What kind of psychotherapy requires collusion between patient and psychotherapist? What kind of message does this send the patient?
If your psychiatrist prescribes medication in conjunction with your psychotherapy, and especially if she acts as your primary care physician, checking vital signs after changes in medication makes perfect sense. Many drugs can cause changes in weight, pulse or blood pressure. But psychiatrists, do not start checking vital signs now just to pad the bill; you will fool neither your patient nor the payer. And patients, if your psychiatrist does try to pad the bill like this, tell him how you feel about it, then considering finding a replacement -- one with integrity.
In the punch line of my favorite lawyer joke we find that one of the reasons we use lawyers now instead of rats for medical research is "There are still a few things you can't get a rat to do." Let us not let this become a psychiatrist joke.

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