Who would have expected that the changes in billing from CPT codes (specifically 90862) for psychiatrists to Evaluation and Management (E/M) codes would be problematic? Not for the psychiatrist, as it offers the opportunity to bill a bit more for more complex issues, as described in the ICAN video series below. Ah, but all is not green in the Emerald City...
It turns out that for many, what was once a 15 minute visit to the psychiatrist (difficult to get in so many places) is turning into a 20-minute visit, because the new coding system requires the collection of more information. So what on earth could be the problem? Well, for starters, a 20-minute visit with a psychiatrist (who is already overworked) means fewer available appointments during the day. Also, an unintended consequence, according to some parents, is that the bulk of the time now gets taken up with the additional questions required by the new code. So here we have a situation where the psychiatrist can potentially get paid more with the new code but may need to schedule a slightly longer session in order to collect all of the required information to be able to bill. Unfortunately, the patient may actually get less time talking about the key issues because of all of the required new information that needs to be collected. Sounds like a Joseph Heller novel to me...
Consider this first-person account from a parent:
- A parent went with her son to the child psychiatrist on January 2. She had her list of concerns and a form that needed to be filled out. Instead, the psychiatrist told her that he had to take down height and weight, get a blood pressure reading and fill out his own form, which included medical questions (When was your last headache? What's the quality of your sleep?) All this took up most of the appointment. She was told they had no time for her questions or her form. She had no idea of any of these changes until she walked in for the appointment. The doctor apologized and said that any new appointments would be 20 minutes, not 15, in order to add time for the additional tasks. That didn't sit well with her. She said it is tough enough to get appointments now -- if they will be 20 minutes, there will be fewer of them, which will make them even harder to get.
Oops, that doesn't sound good. It turns out the AMA issued the new codes to be used beginning January 1st as they felt psychiatrists were not being reimbursed adequately. Click here for an article that discusses the changes.
YouTube has a number of video tutorials for psychiatrists explaining the demise of the 90862 CPT code and the move to the new E/M codes. Some of these videos are almost painful to watch (sort of like watching paint dry) as they deal with coding issues, which are pretty darned hard to make exciting. But what should worry advocates is the anecdotal story from the parent above. This is not a case of "no one will notice the difference." Actually, many will notice the difference and what was intended as a way to compensate psychiatrists for more difficult cases has the potential to become the norm and result in less time focused on what they spent all those years in medical school for. What a mess. The bigger mess is that no one seems to be talking about this. Are you a parent or consumer of psychiatric services who has experienced something similar to the description of the parent above? If so, let us know. We want to start tracking this. As always, we will keep your information confidential.
Scott Bryant-Comstock, President & CEO
Children's Mental Health Network
2013 Psychiatry and Psychotherapy CPT Code Changes
(Note: Everything a psychiatrist needs to know about filling out coding forms. While likely not intended for this type of instructional video, we did not notice any mention of the challenges to both the psychiatrist and the patient that are mentioned above. Let us know if we missed it!)