Replacing CPT codes for psychiatrists leads to unintended consequences for consumers

2 Comments | Posted

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:

 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!)

Comments

  1. Wayzata psychiatrst's avatar
    Wayzata psychiatrst
    | Permalink
    Thanks for posting the instructional video and commentary. All very real problems you've stated - five minutes does matter in the long run for us and for our patients.
  2. Dinah's avatar
    Dinah
    | Permalink
    I also put up a tutorial series, but I have a much stronger emphasis on psychotherapy with medication management.

    http://psychiatrist-blog.blogspot.com/2012/12/tutorials-cpt-coding-for-outpatient.html

    http://psychiatrist-blog.blogspot.com/2013/01/hows-it-going-new-cpt-codes-for.html
    1. Leave a Comment