Policy Issues & Resources: CPT Codes
2013 CPT Code Changes for Psychiatry and Psychotherapy
* New Resource: Updated FAQ Document (3/7/13)
Effective January 1, 2013, there were significant changes to Current Procedural Terminology (CPT) codes for psychiatry and psychotherapy services. The CPT code set is defined by the American Medical Association (AMA) and describes procedures and services by physicians and other health care professionals.
Some of the major changes include:
- Removal of evaluation and management (E/M) plus psychotherapy combination codes from the psychiatry section (90805, 90807)
- Deletion of 90862, the code for pharmacologic management (providers to use appropriate E/M code)
- Addition of code 90785 for interactive complexity
- New codes and time intervals for psychotherapy
- New code for psychotherapy for a patient in crisis
Many of these changes impact billing, contracts, work flow, and compliance protocols. Explore the resources included below to help you prepare for 2013.
If you have questions or have resources to add to this list, please contact the National Council at ninam@thenationalcouncil.org.
If you need additional consultation services on CPT code selection and documentation, please contact:
David R. Swann, MA, LCAS, CCS, LPC, NCC
Senior Healthcare Integration Consultant, MTM Services
Email: david.swann@mtmservices.org
Payers Not Accepting 2013 CPT Codes? That's a HIPAA violation.
Are the payers you work with creating new definitions for the 2013 CPT codes? Or not accepting claims submissions with 2013 CPT codes? Both are HIPAA violations.
The AMA recently released two Practice Management Alerts (on January 7th and January 8th) encouraging providers to report HIPAA violations.
While payers can make benefit and reimbursement decisions, they must "use the current applicable medical data code set valid at the time the health care is furnished." This includes not making changes that are contrary to the guidelines provided in the CPT code set, even if they are using 2013 codes.
The AMA recommends filing a complaint through the Centers for Medicare and Medicaid Services website and/or through the AMA's Health Plan Complaint Form. AMA members and their practice staff can also download sample appeal letters and customize them for use in their practices.
Resources to Get You Through the CPT Code Changes
- National Council's Frequently Asked Questions, with crosswalk (3/7/13)
- AMA Code Book for 2013, available for purchase at www.amabookstore.com or 1-800-621-8335
- National Council fact sheet with crosswalk
- National Council’s Compliance Watch series on CPT
- The Compliance Watch newsletter is designed to help you stay current with regulatory changes and best practices in corporate compliance. It is one of the most unique publications of its kind in behavioral health, giving you the information and guidance needed to reduce and manage risk. The newsletter features articles by experts sharing their successes in reducing audit and investigatory risk while maintaining high clinical standards. Subscribers receive regular email updates listing the latest articles available online, as well as alerts on breaking news. You can subscribe to Compliance Watch by going to: https://store.thenationalcouncil.org/catalog/list_products?category=5
- The new series on CPT codes will offer a number of different articles on the upcoming changes and the first one will be written by David Swann.
- Preparation check list to help your organization get ready for January 1st (this will download an Excel file; it will not open a new web page)
- This list was originally developed by our Minnesota association. See something we should add? Send your ideas to Nina.
- AACAP's Interactive Complexity Guide for use of +90785, the new add-on code for interactive complexity
- Need some levity? Take two minutes to watch our holiday video, "We Wish You a Merry CPT Code Transition!"
- See below for information specifically on Evaluation and Management services
Webinars
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National Council Webinar: "CPT Code Changes: E/M 102, Level Selection and Documentation Support," January 9, 12:00-2:00pm EST
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Note: Changes were made on 1/11/13 to slides #30 and #64
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Handout on Coding for Key Components, referenced in webinar
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- National Council Webinar: “E/M 101: Preparing Your Organization for 2013 CPT Code Changes,” December 3, 1:00-3:00pm EST
- National Council Webinar: “CPT Code Changes for 2013: Impact on Behavioral Health,” November 9, 2012
Evaluation and Management Codes
The 2013 changes in psychiatry and psychotherapy codes demand that providers transition to a different set of CPT codes for medical services: Evaluation and Management (or E/M). Some resources for learning about E/M codes include:
- CMS 1997 Evaluation and Management Guidelines
- American Academy of Child & Adolescent Psychiatry Evaluation and Management Coding Guides and Webinars
- AACAP's E/M Services Guide for Coding by Key Components, which helps select an E/M code based on history, exam, and medical decision making
- AACAP's E/M and Psychotherapy Coding Algorithm, which guides you through how to report services when provided with psychotherapy
Reimbursement and Rate-Setting
Changes that are made to CPT codes are separate from service and reimbursement policy set by payers. It is very important to check with each of the insurance carriers you work with (both privately and publicly-funded) to determine what codes they will cover, at what rates, and if there are any limitations. Your provider contracts may need to be amended; in other cases, a fee schedule update may suffice.
- Medicare: Payment rates for individual services are calculated by Medicare using three different components: Relative Value Units (RVUs), Conversion Factor, and Geographic Practice Cost Indices. On November 1, 2012, CMS published through regulation the RVUs for services for 2013 (except for crisis psychotherapy codes). This is the first step for establishing rates under Medicare. The psychiatry section begins on page 531 of the published rule.
- Medicaid: CPT code changes happen annually and therefore your State Medicaid agencies and payment vendors have a routine process for updating the CPT codes in their system; find out what it is in your state and what to expect by being in touch with people involved with the payment systems.
- Private Payers: Any payers that use CPT codes for reporting or payment will be impacted by these changes. Be in touch with them to find out how they are approaching the transition.
Wondering about the rate differential between 90791 and 90792 (psychiatric services without and with medical services)? See the APA's explanation from February.
Additional Resources
The National Council is providing these resources to assist behavioral health organizations' transitions to the new CPT code set for 2013. The information provided should not be considered a substitute for professional or legal advice on compliance matters.
CPT® five-digit codes, descriptions, and other data only are copyright 2012 by the American Medical Association (AMA). All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in the CPT®. CPT® is a registered trademark of the American Medical Association (AMA).
