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Psychotherapy Codes Major Changes for 2013 ©2013 National Association of Social Workers. All Rights Reserved. 1 © CPT copyright 2012. American Medical.

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Presentation on theme: "Psychotherapy Codes Major Changes for 2013 ©2013 National Association of Social Workers. All Rights Reserved. 1 © CPT copyright 2012. American Medical."— Presentation transcript:

1 Psychotherapy Codes Major Changes for 2013 ©2013 National Association of Social Workers. All Rights Reserved. 1 © CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Mirean Coleman, LICSW, CT

2 Purpose To provide an overview of the new psychotherapy codes which became effective January 1, 2013 To make clinical social workers aware of psychotherapy codes available for use by them To help clinical social workers become HIPAA compliant with electronic code transactions in 2013 ©2013 National Association of Social Workers. All Rights Reserved. 2

3 Revision Process The psychotherapy codes were last revised in 1998 NASW was involved in the revision process CPT Editorial Panel developed a work group Work group consisted of the Academy of Child and Adolescent Psychiatry, American Nurses Association, American Psychiatric Association, American Psychological Association, and NASW ©2013 National Association of Social Workers. All Rights Reserved. 3

4 Why Change the Codes Since 1998, mental health services changed (1)Reduction in inpatient beds, creating large volume of outpatient mental health services (2) Work intensified in outpatient services (3) Co-morbid conditions increased ©2013 National Association of Social Workers. All Rights Reserved. 4

5 Deleted Codes 90801: Psychiatric Diagnostic Interview 90802: Interactive Psychiatric Diagnostic Interview 90804, 90806, 90808: Individual Outpatient Psychotherapy 90810, 90812, 90814: Interactive Individual Outpatient Psychotherapy ©2013 National Association of Social Workers. All Rights Reserved. 5

6 Deleted Codes 90816, 90818, 90821: Residential Individual Outpatient Psychotherapy 90823, 90826, 90828: Interactive Individual Outpatient Psychotherapy 90857: Interactive Group Psychotherapy ©2013 National Association of Social Workers. All Rights Reserved. 6

7 Codes Without Changes 90845: Psychoanalysis 90846: Family Psychotherapy (without the patient present) 90847: Family psychotherapy (conjoint psychotherapy, with the patient present) 90849: Multiple-family group psychotherapy ©2013 National Association of Social Workers. All Rights Reserved. 7

8 Codes Without Changes 90853: Group psychotherapy (other than of a multiple-family group) 90880: Hypnotherapy 90889: Preparation of report of patient’s psychiatric status, history, treatment or progress (other than for legal or consultative purposes) for other physicians, agencies, or insurance carriers. ©2013 National Association of Social Workers. All Rights Reserved. 8

9 Family of Codes Without Changes Health and Behavior Assessment and Intervention Codes were not changed These codes identify services focusing on bio- psychosocial factors affecting physical health problems ©2013 National Association of Social Workers. All Rights Reserved. 9

10 Family of Codes Without Changes 96150: Health and behavior assessment 96151: Reassessment 96152: Health and behavior intervention, individual 96153: Group (2 or more patients) 96154: Family (with the patient present) 96155: Family (without the patient present) ©2013 National Association of Social Workers. All Rights Reserved. 10

11 Family of Codes Without Changes Medical Team Conference Codes (1)Face-to-face participation by three or more licensed health care providers from different health care specialties. (2) Participants are actively involved in the development and coordination of health care services. ©2013 National Association of Social Workers. All Rights Reserved. 11

12 Family of Codes Without Changes 99366: Medical team conference with interdisciplinary team of health care professionals, face-to-face with patient and/or family, 30 minutes or more……… : Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more……. ©2013 National Association of Social Workers. All Rights Reserved. 12

13 New Codes Several new codes were developed Individual psychotherapy codes were deleted Services are for face-to-face services only All settings are included Evaluation and Management component was separated in the diagnostic interview ©2013 National Association of Social Workers. All Rights Reserved. 13

14 New Codes 90791: Psychiatric Diagnostic Interview An integrated, bio-psychosocial assessment, including history, mental status, and recommendations ©2013 National Association of Social Workers. All Rights Reserved. 14

15 Coding Tips for Can only be reported once a day Can be used more than once if needed Are only for the patient, and not the informant Does not include psychotherapeutic services ©2013 National Association of Social Workers. All Rights Reserved. 15

16 Other New Code 90832: Psychotherapy, 30 minutes with patient and/or family member. The time range for this code is 16 to 37 minutes. ©2013 National Association of Social Workers. All Rights Reserved. 16

17 90834: Psychotherapy 45 minutes with patient and/or family member The time range for this code is 38 to 52 minutes. ©2013 National Association of Social Workers. All Rights Reserved. 17 New Code

18 90837: Psychotherapy 60 minutes with patient and/or family member The time range for this code is 53 minutes or more. New Code ©2013 National Association of Social Workers. All Rights Reserved. 18

19 Time Factor Recommendation Follow the time specified in the code descriptor in order to avoid possible overpayment requests especially when an insurance company requests documentation of the start and stop times of the psychotherapy session. ©2013 National Association of Social Workers. All Rights Reserved. 19

20 Time Coding Tip When patient is seen beyond 90837, 60 minutes, then a prolonged service code can be used if patient is seen for a minimum of 90 minutes. ©2013 National Association of Social Workers. All Rights Reserved. 20

21 Prolonged Service Codes Prolonged Service Codes include Prolonged Service With Direct Patient contact Check with your insurance company to see if they will allow you to use this code. ©2013 National Association of Social Workers. All Rights Reserved. 21

22 Coding Tips for 90832, 90834, The psychotherapy session identified in these codes is primarily with the patient, not the family The family is used to obtain information Psychotherapy concerned with the effects of the patient’s condition on the individual being interviewed is not reimbursable as part of the clinical social worker’s services to the patient. ©2013 National Association of Social Workers. All Rights Reserved. 22

23 Coding Tips for 90791,90832, 90834, When using these codes, the patient should be the primary receiver of psychotherapy services Clearly document this in the patient’s record to avoid overpayment requests ©2013 National Association of Social Workers. All Rights Reserved. 23

24 Interactive Complexity is an add-on code for interactive complexity Report with 90791, 90832, 90834, 90837, and Refers to communication factors that complicate the delivery of psychiatric procedures. ©2013 National Association of Social Workers. All Rights Reserved. 24

25 Interactive Complexity Common factors include: (1)More difficult communication with discordant or emotional family members (2) Engagement of young and verbally undeveloped or impaired patients ©2013 National Association of Social Workers. All Rights Reserved. 25

26 Interactive Complexity Typical patients are: 1.Third-parties such as parents, guardians, and other family members 2.Interpreters, language translators 3.Agencies 4.Court officers 5.Schools involved in their psychiatric care ©2013 National Association of Social Workers. All Rights Reserved. 26

27 Interactive Complexity Factors present with patients who: (1)Have other individuals legally responsible for their care (2) Request others to be involved in their care during the visit (3) Require the involvement of other third parties ©2013 National Association of Social Workers. All Rights Reserved. 27

28 Interactive Complexity Interactive complexity procedures may be reported when one of the following is present: (1)The need to manage maladaptive communication among participants complicates delivery of care. (2)Caregiver emotions or behavior that interferes with the caregiver’s understanding and ability to assist with the treatment plan ©2013 National Association of Social Workers. All Rights Reserved. 28

29 Interactive Complexity (3)Evidence or disclosure of a sentinel event and mandated report to third-party with the initiation of discussion of the sentinel event and/or report with patient and other interview participants (4)Use of play equipment, other physical devices, interpreter, or translator to communicate with the patient to overcome barriers to the therapeutic or diagnostic process ©2013 National Association of Social Workers. All Rights Reserved. 29

30 Interactive Complexity Use with a patient who (1)Is not fluent in the same language as the clinical social worker (2) Has not developed, or has lost, either the expressive language communication skills to explain his/her symptoms and response to treatment ©2013 National Association of Social Workers. All Rights Reserved. 30

31 Psychotherapy for Crisis A new service identified through coding An urgent assessment and history of a crisis state, a mental status exam, and a disposition. Presenting problem is life threatening or complex and requires immediate attention ©2013 National Association of Social Workers. All Rights Reserved. 31

32 Psychotherapy for Crisis Treatment includes (1) Psychotherapy (2) Mobilization of resources to defuse the crisis and restore safety (3)Implementation of psychotherapeutic interventions to minimize potential psychological trauma ©2013 National Association of Social Workers. All Rights Reserved. 32

33 Psychotherapy for Crisis 90839Psychotherapy for crisis, first 60 minutes 90840Each additional 60 minutes This is an add-on code. List separately in addition to ©2013 National Association of Social Workers. All Rights Reserved. 33

34 Coding Tips for and Must devote your full attention to the patient Cannot provide services to another patient during the same time period Patient must be present for all or some of the service Report total face-to-face time with patient and family even if the time is not continuous Can only report once a day ©2013 National Association of Social Workers. All Rights Reserved. 34

35 Time Factors for and : Psychotherapy, 60 minutes 30 to 74 minutes. Cannot use this code if service is less than 30 minutes. Instead, use : Can only add on to if crisis is beyond the first 74 minutes. ©2013 National Association of Social Workers. All Rights Reserved. 35

36 Payment for New Codes CMS assigned interim values to the new codes This was done because the survey process of the psychotherapy codes is incomplete We may not know until 2014 what the permanent rates will be The interim values set by Medicare has impacted the rates set by other insurers ©2013 National Association of Social Workers. All Rights Reserved. 36

37 Payment for Codes Codes to be surveyed are: (1) Psychotherapy for crisis: carrier-priced (2) Psychotherapy for crisis: carrier-priced (3) Interactive Complexity: carrier-priced ©2013 National Association of Social Workers. All Rights Reserved. 37

38 Advocacy for Codes NASW continues to advocate for clinical social workers in the coding process Will participate in the survey process in February 2013 to determine work and practice expense values for 90839, and Clinical social workers are encouraged to participate ©2013 National Association of Social Workers. All Rights Reserved. 38

39 Questions and Answers Additional questions can be answered at “An Hour With Psychotherapy Codes: Questions and Answers.” It will be held on Wednesdays beginning January 23, 2013 through April 24, 2013 from 12:00 pm to 1:00 pm EST. There is no fee for this teleconference which is opened to NASW members. Name: Psychotherapy Codes Teleconference Number: Participate Passcode: ©2013 National Association of Social Workers. All Rights Reserved. 39

40 January 22, ADDENDUM Since the Webinar presentations, New Psychotherapy Codes: Major Changes for 2013, on January 11 and 17, the Centers for Medicare and Medicaid Services informed the CPT Editorial Panel they will not reimburse non-physician Medicare providers for the use of the prolonged service code, 99354, with Clinical social workers should speak with each insurance company in which they are a provider to determine how they may be reimbursed for services which extend beyond the time frame for 90837, especially since has been deleted. NASW is working with the American Medical Association, the Centers for Medicare and Medicaid Services, and other mental health organizations to rectify this problem. Members will be updated on future coding information as it becomes available. ©2013 National Association of Social Workers. All Rights Reserved. 40


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