If you’re a psychiatrist (or psychiatric RNCS) in the US reading this, you are almost certainly aware that all of our billing codes changed on Jan 1, 2013. If you are like most of the psychiatrists I know—at least in private practice—you are at least somewhat freaked out by this. If so, keep reading. If not—for example, if you’re not a psychiatrist in the US—stop reading this immediately and go do something more interesting, like… well, like just about anything other than memorizing a phone book. (There used to be things called phone books… never mind.)
I made up a one-sheet reference, which I think can help with the codes. There are links to it at the bottom.
Here are some links that I’ve used for reference, trying to understand this. The “little” APA has a helpful page with many links, most of which are pdfs available to both members and non-members, at http://www.psychiatry.org/cptcodingchanges. The “Overview of the 2013 Changes ” will get you started; the last two pages, which are also included separately as “E/M Summary Guide: Coding by Key Components,” were the single most helpful reference for the complexity-based E/M codes, which you will quickly realize are the only really challenging issue here. I also found the “Patient Examples Outpatient E/M Visits” helpful. And finally, the comprehensive reference seems to be “Evaluation and Management Services Guide from CMS .” (Note that while the APA site says that it “does not replace content found in the 1997 Documentation Guidelines for Evaluation and Management Services, abridged version for psychiatrists [listed above],” it seems to contain the full 1997 guidelines as an appendix, so I’m not exactly certain what they mean…)
My advice, at least at the beginning, is to avoid the E/M codes for initial visits, and use the generic initial evaluation code, which replaces 90801. Some of the E/M codes for initial visits will probably end up reimbursing better than the generic code. Again, my advice: save that for later.
Unfortunately you need to use the complexity-based E/M codes if you are doing psychotherapy and medications together (e.g., the old 90807), which you now need to code with a complexity-based E/M code and a psychotherapy “add-on.” I suspect I will mostly end up using 99212 and 99213, but some colleagues have pointed out that 99214 is workable, especially for those doing geriatric psychiatry.
So, with the exception of the initial-visit E/M codes, I boiled it down into a one-page reference, which anyone is free to redistribute as far and wide as they link. Links are at the bottom of this page. When you click on that link, if the file opens in a browser window rather than downloading, you should just be able to go to “Save” in your browser’s File menu to save the pdf or .doc file on your hard drive. I am not charging for it (though in the spirit of “shareware” I’m happy to accept donations from anyone who feels so moved, see the “Support” button to the right). I’m making it available as “open source” material under a Creative Commons license (more info at the bottom), which means that you could change it and redistribute it as long as you do so in compliance with the license (meaning that if you change it and distribute it to others you attribute the original). The license actually does not rule out commercial use.
Feedback and comments are welcome! (I am aware, by the way, that I made one simplification: it is possible to hit the criteria on medical decision-making based on problem and data points alone, but I can’t really ever see that happening without also hitting the risk criteria).
And of course, the obligatory disclaimer. I am not an expert in this stuff, this is simply my best understanding of it. It is quite possible that there are errors in the reference, and if you find any, please tell me. But you are, as always, responsible for your own coding and documentation and I can’t assume any responsibility for any problems that come up for anyone but me.
I’ve also made a form for taking notes in session (or for learning the system between sessions) which should make documentation and coding easier. More information at tiny.cc/emform.
So here are the links:
- I will try to keep this a link to the current pdf
- I will try to keep this a link to the current Word .doc file
- This is a link to the original pdf of 1/5/13
- This is a link to the original Word .doc of 1/5/13
- The link tiny.cc/cpt2013 can be distributed to anyone who’s interested; it points back to this blog entry, and I plan to keep it pointing either here or to some other explanatory page
- The link tiny.cc/natpsych points to this blog as a whole
I’ll try to keep the “current” links up to date so you don’t have to chase around to find the current version; on the other hand, if you don’t like the changes you can stick with the original. Each intermediate version should have a blog entry so that it can be found as well.
The licensing information: