CPT Code Changes 2013
What are CPT Codes?
Current Procedural Terminology (CPT) codes are developed by the AMA, who contracts with CMS to be the official coding system
Magellan must buy licenses from AMA to use CPT codes
Describes medical, surgical, diagnostic services
Under HIPAA, providers and insurers are required to use CPT codes to identify their services Identifies services rendered rather than diagnoses as in DSM and ICD-9 and 10
Communicates uniform information about medical services and procedures
CPT Code Changes for 2013
The AMA issued major changes to behavioral CPT codes impacting both payors and providers. CPT codes changes affect 908x series therapy codes including the replacement of 90862, and require the use of 99 codes, specifically the 9920x and 9921x series, by psychiatrists and advanced practice nurses. These changes apply to any services provided beginning January 1, 2013. Numerous Magellan work groups have been working diligently since May to update our systems for this change.
The Big Picture
The new CPT codes are mandatory; non-compliance is a HIPAA violation. The switch to the new codes is based on the date of service, not the date the claim was submitted. For dates of service prior to Jan. 1, you can bill with the old codes and the claim will pay. The AMA does not allow for a transition period. Providers must bill with new CPT codes on Jan. 1 for dates of service on or after Jan. 1 or the claim will deny. This includes electronic claims.
Code changes impact all provider types, not just psychiatrists.
The Changes 908xx 90862
Most 908xx codes we are familiar with have been changed Medication management, has been eliminated Psychiatrists and other physicians must use E/M (Evaluation and Management) codes 992xx with an add-on code if psychotherapy is performed 90801 has been eliminated Now initial evaluation with medical services90792; without medical services 90791
992xx 90801 90792 and 90791
Interactive
If initial evaluation code 90791 or 90792 is interactive, appropriate add-on code must be used Interactive code may be used with E&M only when add-on psychotherapy codes are used
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The Changes
90839
Psychotherapy for patient in crisis-60minutes
+90840
Crisis beyond 60 minutes, +90840 per each additional 30 minutes
+90863
Add-on for medication management and psychotherapy by psychologist
Whats An Add-On Code?
Used in conjunction with another primary code-indicated by a (+) Added to 99xxx codes to denote psychotherapy in addition to evaluation and management services (see next slide) Added to denote interactive psychotherapyuse of device or interpreter +90785 Initial evaluation codes (90791 or 90792)
To evaluation and management codes (99xxx codes) if add-on psychotherapy code is used To psychotherapy codes To group psychotherapy codes Used with crisis therapy for each 30 minute session beyond the first hour +90840
Psychotherapy Codes
Codes simplified and expanded
Includes time with patient and/or family member Only 3 timed codes: 90832 90834 90837 +90833 +90836 +90838 30 minutes 45 minutes 60 minutes
If E/M provided, timed add-on codes for psychotherapy 30 minutes 45 minutes 60 minutes
A Few Codes Remain the Same!
90845
90846
90847
90849
90853
Psychoanalysis
Family therapypatient not present
Family therapypatient present
Multifamily group treatment
Group therapy
Evaluation and Management (E/M) codes
Psychiatrists must use E/M codes for services such as medication management These codes are the same ones all physicians use for similar services, and use the numbers 99xxx Documentation requirements are much more specific for these codes and require addressing various degrees of medical complexity APA has a training program online for psychiatrists in the use of these codes Physician extenders will also use these codes, but not other mental health professionals
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Evaluation & Management Services
Office/Outpatient services 99203-99205 99211-99215 9924x 99221-99223 99231-99233 Nursing facility care Home visit New Patient Office Visit Established Patient Office Visit Outpatient Consult
Inpatient/Hospital Services Initial Hospital Care Subsequent Hospital Care 99304 99341
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Case Examples
John Smith, MD is providing medication check services to Mr. Jones. He spent about 15 minutes with the patient. What code should he bill Magellan?
99212
After this patient, Dr. Smith evaluates a new patient who does not speak English, and an interpreter is used.
What code should he bill Magellan?
90792+ 90785
Dr. Smith has asked his LCSW, Ms. Brown, to lead a group therapy session with 8 patients.
What code should she use to bill?
90853
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Case Examples
Dr. Green is conducting a 60-minute psychotherapy session. During the session, the patient becomes agitated, psychotic and suicidal. Dr. Green must spend an extra 30 minutes to calm him down. What code should he use to bill?
90839+ 90840
Dr. Green is having a session with a 13-year-old patient for depression and alcohol abuse. The patient is on an antidepressant and an inhaler for her asthma. She presents with both of her parents, who are divorced and arguing over how to address the patients recent alcohol binge. One parent wants to send her away to a boarding school. The other parent wants to follow the previously agreed upon course of treatment.
What code should he use?
99212 +90836 +90785
Dr. Smith has a patient in the hospital. He conducts a 45minute psychotherapy session, and evaluates the patients reaction to his medication.
What code should he use?
99221+ 90836
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Communicating Updates
What you can expect to see from us: A dedicated CPT Code page, which offers updated information and links, on www.MagellanHealth.com/provider under Getting Paid/HIPAA News Headlines and Provider Focus articles on the provider site A reminder notice when logging on to our secure provider website CPT Code messages on hardcopy EOBs A contract amendment mailing with FAQs Provider webinars And, additional regional outreach as needed
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Questions
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