Wednesday, November 21, 2012

My Struggles to Learn the New CPT Codes



Okay, I'm starting to document my attempts to learn the new CPT codes.  Check out my article on Clinical Psychiatry News called "One Psychiatrist's Quest to Learn New CPT Codes for 2013." 
The article has a little bit of attitude to it, but I do wish this was going to be easy.  I do want to tell you that the part about the Amazon reviewer who says the manual is made of paper that is comparable to Russian toilet paper, that is true ( that they said it, I have never felt either the AMA's CPT manual or Russian toilet paper), I did not make that up.

So while the new CPT codes may better capture what it is that we do as psychiatrists, and may eventually end up being fairly straight-forward for those who do only psychotherapy without prescribing, or those who do only medication management, for the psychiatrist who does both and does not participate in insurance networks, it's going to be difficult.  One code, 90807, has captured most of what I do clinically: a 50 minute psychotherapy session with medication management.  The new codes now have 15 variations to capture that same appointment, 3 based on the time devoted to psychotherapy, and 5 based on the complexity of what happens in terms of medication management, medical assessment, education, or coordination of care. If crisis management or difficult family members, or 3rd party reporting are necessary during the session, there can be even more codes.  Technically, every session might have different codes with  different fee, ones that can't be predicted in advance.  I'm sure we'll figure this out, but I don't think the people who designed these codes were thinking about the way every psychiatrist practices.  The challenge is going to be to come up with a consistent coding structure that captures what we do so that the patient can be maximally reimbursed, while the integrity of the system is maintained.

I haven't taken the official course yet, I've just been chatting with people and looking at some of the slide shows the professional organizations have put out.  I hear colleagues say that the documentation is onerous, and I wonder if this will change care.  The more medically complex the appointment, the higher that portion of the reimbursement will be.  Oh, but having a more medically complex appointment may then require that less time is spent on psychotherapy, and that part of the fee reimbursement will go down.  It's all very confusing.    And while the psychotherapy must be distinct in terms of time, the reimbursement for psychotherapy is higher if there is not medication involved, so 30 minutes of a physician's time devoted to therapy (which are distinct from the medical management) pays less than 30 minutes of psychotherapy time by someone who is not also managing medications.  Finally, it's not at all clear why the new Medicare fees have a psychiatric evaluation with medical services done by a physician being reimbursed less than a psychiatric evaluation done by someone who is not a doctor.

If you're a patient, hang on, we'll figure this out.  If you're a psychiatrist and you've come up with a solution to how to make this work, please do tell.