Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.
AAAAUUUUUUUUGGGGGGHHHHHHHHH......Please....please....make it stop.Dinah, you're on vacation. CPT codes? On vacation? Really?
worst part to come.. REIMBURSEMENTShint: psychiatrist and therapist reimbursed the SAME for 60 minute initial Eval; also- same reimbursement for 99213 and 99212;thank you APA,AMA, and Obama voters
Anybody taking this poll is obviously self-selecting. What exactly do you intend to take away from this incredibly unscientific poll with a non randomized sample? Also, Anon commenter - seems like your issue is that a regular old therapist not be reimbursed the same as you, a grand psychiatrist. I've seen plain old therapists succeed with patients with whom I've failed.
Clink: it's an illness, we've determined that. I can't help myself. Anon: I thought therapists were reimbursed better than psychiatrists for evals. I don't recall seeing that 992130 is the same as 99212, can you provide a link.Anon8: Incredibly unscientific information which I may or may not present or write about, but if I do, I will do so with the caveat that it's unscientific, not validated, not randomized, and an uncontrolled audience. It is what it is. Polls are fun, it helps with my curiosity, and there's not another way to get at this info.
Anon8: talikng about unscientific: who said I was a psychiatrist?? Unlike you, I am objective. Dinah: you are a breath of fresh air. I believe reimbursements are payor-specific, so I am talking in general. I believe the therapist reimbursement for an eval is going up, making it now equal to the psychiatrist eval. Anon8ArgumentativeUnobjectiveEntityLikelyObamaVoter cannot understand why it is disconcerting for "Eval with Medical" to be reimbursed same as "Eval without Medical" (if it is less, than that is even more outrageous)// regarding 99213 reimbursement same as 99212, again this is payor (and maybe provider) specific, so I am basing info on anectodal reports so far.
Hi, I've never written on a blog before, so hear goes...first thank you Dinah for all the information you have provided with the you tube videos and articles, they have been very helpful. I am a psychiatrist in private practice in Indiana and do psychotherapy and med management with most of my patients. About half my practice is Anthem or Medicare so I've been careful about documentation. Even with all the education, I still don't understand how to change my fee schedule and charge for the combined codes, and how to explain all this to my patients. I can't get Anthem to call me back and I have a lot of questions!! I can't believe this has been implemented so quickly with so little consideration for how we actually work.
How do you tell patients, who have been seeing you weekly for a set fee, "now your fee will vary week to week depending on how much E/M work we do..." Really???? Am I understanding this correctly?
Laura, the alternative is to select your e/m code based just on time, which you may do if "more than 50% of the time is for 'counseling' (not psychotherapy) and 'coordination of care.'"
Laura, Congrats on your first oomment!I have been telling patients who have Medicare that their fee may vary each session depending upon what we talk about and I've been telling patients with private insurance (I'm out-of-network) that their reimbursement may vary (the fee will be the same).Truthfully, yes you are right for the outpatient established patient codes, but this assumes no psychotherapy because you can't bill based on time if you use a psychotherapy add on code, and it also depends on the content of the session. For time-based coding, as you've mentioned, you have to spend over half the session in counseling and coordination of care and I find it an odd concept that the psychiatrist should spend more than half of the session doing the talking. And to do that as an alternative presumes you know before the patient comes in if that will happen. It seems fine for shorter appointments. My guess is that psychiatrists will want to use both codes (psychotherapy plus e/m) if they are meeting for 30-60 minute sessions.
Yes Dinah, I am referring to shorter sessions. I believe we are being squeezed to do just that. More frequent appointments may be need, as well as lower threshold for referring to separate therapist. But in my opinion a whole lot more ethical than a patient being charged more for (and therefore dissuaded from) sharing serious information. I agree with Anonymous on a big thank you to APA, AMA, and Obama.
Also, what's ethical about a patient being charged more and dissuaded from continuing psychotherapy?I'm planning to opt out of Medicare, but can't get it accomplished until April 1, so I will do my best to explain to them why I'm doing that, and why they will have different charges and different co-pays in the meantime. Is there an E/M code for that time? Ugh.Also agree with Anonymous. I've been in APA since residency (20 years), and I feel betrayed. I know things need to change in but this is the most stressed and unsupported I've ever felt in my career.
The time spent figuring out which non-time-based e/m code to use does not help one be a good psychiatrist- it is time taken away from being a good psychiatrist. Therefore, the only ethical solution is to use to e/m codes based STRICTLY on time, and refer all "psychotherapy" out. We have been squeezed.
Patient perspective - if my reimbursments aren't coming back at the rate I'm used to and budgeting for, then I will have no choice (literally) other then cut back on sessions, or switch to medication maintenance. (Currently, psychiatrist provides meds and weekly therapy and does not accept insurance; I submit for reimbursement.) This in turn will directly affect my psychiatrist's fees, especially if other patients are forced to do the same. Not sure how this is a tenable situation. None of you are concerned with this?
Now I see why my psychiatrist doesn't take insurance. I feel for all of you trying to help those without a silver spoon in their mouth. Thanks for facing the struggle. You are appreciated.
You may be missing the real point here which is that this is nothing but a promotion of 3d party reimbursement at the expense of those who pay cash or even those who have not satisfied their deductibles. I will simply substitute 99212 for the old 98162, and let my patients fight their inscos. I refuse to play the upcoding/bullets game. APA has turned against private practice psychiatrists.
Moviedoc,Is this what you have already been doing (being an out-network provider, requiring payment up front, w pt to battle ins co for their reimbursement)?Just wondering, as I am looking at going in that direction, but right now most here are accustomed to just paying their copay.
last anonymous - paying a copay is very different then paying a $200-$300 out of pocket fee for a doc who doesn't take insurance. No idea what moviedoc charges but my out of network psych. who does therapy as well bills $300, which is common for the city where I live. Currently, insurance reimburses most of it, and is the only way I can afford to see this doctor. Obviously, it makes a difference if the psychiatrist doesn't take insurance and isn't willing to make an effort to maximize insurance reimbursement. If my reimbursement shrinks significantly, obviously I will need to look for a shrink who accepts insurance --0 or who is willing to "play the upcoding/bullets game" - aka, make an effort to maximize insurance reimbursement for his patients.
That's another question I have too, about copays. Will there be more than one copay with billing 2 cot codes if you do psychotherapy too? I've been willing to stay in network to provide services that are affordable, and I'm really torn about making the patients pay up front and battle about getting reimbursed by insurance. I am having some thoughts about LOWERING my fees if I go off insurance panels to keep it affordable for middle class people (if there are any left after we slide off the fiscal cliff that is!).
Thank you Laura 1019. I have been in practice for almost 20 years. I have taken Anthem Blue Cross only but have decided to opt-out of that as of January 1 because of this mess. Not that not being on any insurance panel will protect me from an audit.Thank you APA for not standing up for us and doing a poor job of getting input from psychiatrists.
Well, as far as I have read and learned, Value Options and United Behavioral Health are NOT letting psychiatrists bill for E/Ms and a 9083- code for the same day, and I still am not sure you can legitimately get away with not billing for the code that replaces 90801 for psychiatry for the first visit. Oh, and Medicare is only paying $92 for that visit.As said above more than once, this change does NOTHING for private practice psychiatry hereon, so I am taking the cue, to the head figuratively, and cutting my loses.Patients better be ready for some real ugly experiences in 2013 with docs who still take insurance. Not inferring that all physicians will be doing anything unethical or fraudulent, but, I bet there will be a sizeable percentage who do less than savory things to get reimbursed.And for the APA to charge $200 to non members to attend their course on navigating this crap, that is only adding insult to injury! That alone shows to me how insensitive the APA is to the profession these days!!!Joel Hassman, MDwww.cantmedicatelife.com
When do you plan to release your poll results by the way? I would sincerely be interested in the results.
Joel Hassman, patients will have ugly experiences with psychiatrists who are not taking insurance as well, especially those not willing to maximize insurance reimbursement. In the end, it is the patient who is harmed. If the difference is big enough between prior reimbursement amounts and new reimbursement amounts, and the doc is not willing to work to figure out how to (legally) maximize reimbursements, patients will have no choice but to seek other care. It's a lose-lose situation for all.
Finally, after doing a little preliminary reading, I watched the videos Dinah made, and so now share completely the shock Dinah has expressed (please add whatever expletives you favor). Yes, I do not see how I can do this while practicing in the way I have for the last several decades. I try to do the best I can for my patients and so do not yet see how to effect this new billing scheme (British usage).Here's a curious thing: the American Psychological Association has been putting out information for their APA members on the coding. They also will be using 90836, 37, 40 and so on and the information they are sharing is helpful to us, too. It's available on the web.It is clear that what our APA has been doing reflects the fact that psychiatry as a profession has changed a great deal. For outpatient work there is no substitute on our profession for careful, thoughtful, educated listening - I don't see how anyone can do that while doing what is being asked.
link to "overview of the 2013 changes" has an exceptionally simple, clear cut algorithm and list of the changes. It'll be a pain in the ass not to just write 90807 every time but using the new codes is only going to add a couple of minutes time until I'm used to writing the two codes instead of one.
@anonymous: could you give the link? There are several summaries out there....
Oops - sorry I left that part off. The link is http://www.psych.org/practice/managing-a-practice/cpt-changes-2013/current-procedural-terminology-cpt-code-changes-for-2013The first link is a download that's exceptionally clear.
I am hospital based so may not affect me that much, but is still going to be a pain is some way or another for someone.
Well, here we are at the end of the first week in the new reality of 2013 CPT coding. I have tried to inform my patients about the new changes and I'm still not sure what to charge. I would love to hear what other psychiatrists who practice as I do (both psychotherapy and med management on a regular basis) are saying to their patients and what they are doing about their fees. My desire is for the cost to be the same for my time, but does that mean I'm hurting my patient's ability to get reimbursed if I go out of network? I am so confused. I would also be interested in the results of your poll, Dinah! Thanks!
To Laura above, I am getting out of private practice for a good period of time and just working community mental health or other salaried position that has administration to deal with this coding crap. As noted above, the APA has basically said "screw you private practice docs with a conscience".I really am looking forward to hearing about colleagues getting audited in the next year or so who are billing 2 codes at a time pervasively, yet the data shows they are still doing 15 min med checks. And there will ones out there doing this.Oh, and the ones who I have read at other blog threads planning to start practicing primary care to "get your bullets", well, hope ya wearin' a flak jacket with that plan!Again, look forward to reading the results when you have gained enough participants. What is your desired "N"?
Oh holidays and vacation, but I think the rest of the world is in the same mode. There are 85 responses as of last check. At least 100 would be nice? There are certain trends that have been there since the beginning, the percent of people who were using E/M codes before has not changed, the percent who are more worried has not changed. Surprisingly few prescribers who see no psychotherapy patients.
There is not enough mental health care. No one cares until someone shoots a bunch of people; and then of course the mental health community is to blame. People with mental illness have always been the victims of discrimination regarding health care. I have tried to fight the good fight. I have met with ceo's of insurance companies, called my state representatives, congressman, senators and my governor. Just when I thought it could not get worse, here come the government mandated coding changes under the affordable care act, aka obamacare. Thanks a lot. There is no way I can being to even understand how to code. The E/M coding has documentation standards, billing implications. I already know that the insurance companies have stated that they may want documentation before they pay...so expect delays. I can not keep up with the billing, the prior authorizations for medications as well as the new government mandated regulations. These changes have done nothing but increase premiums for private health insurance, increased deductibles and out of pocket expenses and do not provide health care for all. Why must these changes take place? Who does it benefit?
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