Change on the Horizon for Psychiatric Medicine




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Fear and uncertainty has plagued the implementation of the Affordable Care Act (ACA) since its inception. There have been wins and losses on both sides, and medical professionals across the country have had growing concerns that the continued battle amongst political parties would increase the gap between quality care and reimbursements. Recent events indicate more changes directly related to psychiatric medicine are on the horizon.

One of the greatest victories for both the insurance industry and health providers has been achieved with the announcement that the Obama administration has moved to increase Medicare Advantage payments to insurers by 3.3 percent for 2014. This falls on the heels of the Administration’s initial endeavor to cut those same reimbursements by 2.2 percent in 2014. Meanwhile, the field of psychiatric medicine remains vulnerable to new changes implemented through the ACA, such as the recently released ICD-10 and CPT code modifications.

The mandated ICD-10 and CPT code changes has only proven to further increase the problematic issues the public faces in finding, receiving, and paying for mental health services. A 2008 survey conducted by the AMA evidenced that of the psychologists consulted, 33% of their clients paid for their services out of pocket, leaving 67% of service payments made through billing insurance companies. It should be noted that most of these were claims filed with programs funded by federal, state, and local governments.

The ACA has taken measures to try and serve the needs of U.S. citizens who require assistance and treatment from mental health professionals. Mandates are now in place requiring insurance carriers to include comprehensive options for mental healthcare within each health insurance plan. This should result in a large reduction in the growing number of individuals who forgo necessary mental health treatment due to financial constraints.

And yet a major issue remains enticing more private practice mental health professionals to accept both public and private health insurance. In an effort to provide mental health professionals with a better understanding of the ICD-10 and CPT code changes, the APA released a series of documents summarizing major CPT code changes that directly affect the field of psychiatric medicine. Here is a brief summary of these documents (important links to these changes can be found in the references):

  • Document 90862 has been deleted in one of the biggest CPT code changes. It has been replaced with the appropriate 99xxx series E/M code, which requires more documentation, even up to 11 separate elements. The 90862 code paid lower than a 99214 E/M code for Moderate Complexity.
  • Replace 90801 (Initial Psychiatric Evaluation) with:
    • 90791 (and 90785 report with interactive complexity when appropriate): Psychiatric diagnostic evaluation without medical services.
    • 90792 (and 90785 report with interactive complexity when appropriate): Psychiatric diagnostic evaluation with medical services. New patient E/M codes can be used instead of 90792.
  • Replace 90802 (interactive diagnostic initial evaluation) with:
    • 90791 and 98785 report with interactive complexity
    • 90792 and 98785 report with interactive complexity
  • Replace 90804, 90816, 90806, 90816, 90808, 90821 to be used in all settings (in relationship to time with patient and or family) with:
    • 90832: 30 minutes psychotherapy
    • 90834: 45 minutes psychotherapy
    • 90837: 60 minutes psychotherapy
    • Report with interactive complexity and 90785 when appropriate in all three cases
  • Replace 90810, 90823, 90812, 90826, 90814, 90828 to be used in all settings (in relationship to time with patient and or family) with:
    • 90832: 30 minutes psychotherapy
    • 90834: 45 minutes psychotherapy
    • 90837: 60 minutes psychotherapy
    • Report with interactive complexity and 90785
  • Replace 90805-90809, 90817-90822 Psychotherapy & Evaluation Management (E/M) with:
    • Proper E/M code (not chosen based on time) and 90833 add-on code for psychotherapy 30 minutes
    • Proper E/M code (not chosen based on time) and 90836 add-on code for psychotherapy 45 minutes
    • Proper E/M code (note chosen based on time) and 90838 add-on code for psychotherapy 60 minutes
    • Report with interactive complexity and 90785 when appropriate and/or required
  • New Psychotherapy for crisis 90839 and 90840
  • Replace 90857 Interactive group Psychotherapy with:
    • Group psychotherapy 90853 and report with interactive complexity 90785
  • These CPT code modifications present major changes that will directly affect the fields of psychiatry and psychotherapy. This is the first time in almost two decades that CPT code changes have been directed specifically to psychotherapy services. Although some professionals may find it tedious and difficult to make the change, the overall compatibility of the codes and processes will link to those already used by primary care physicians, as well as other service providers.

    References

    American Psychiatric Association, Current Procedural Terminology (CPT) Code Changes for 2013: The Basics.

    American Psychological Association, Insurance Module, 2008 APA Survey of Health Service Providers, (2009, August).

    Kaiser Health News, Medicare Boosts Rather Than Cuts Payments To Advantage Plans, (2013, April 2).

    Image via Krivosheev Vitaly / Shutterstock.

    • Gabby

      Good thing I don’t qualify. I’ll need it in a couple years though. When I was a teenager I couldn’t work because I was dealing with issues, and as an adult I was a full time student and spent the last four years in college.

      I have gotten NO AID whatsoever FROM THE GOVERNMENT. But thanks to some odd stroke of luck I got a grant to go back to college, so I can graduate. I live in the poorest state in the country, West Virginia, or close enough. At least, the most affordable college that I know of.

      My mom’s disabled, my dad’s a workaholic. The only thing we’ve ever got were grants and scholarships. We get no help. No one gets help here. While you’re at it OBAMA, why don’t you fix the fucking educational system? Yeah.

      Really. 20,000 dollars to go to college, and my cousin’s in debt for the rest of her life. I didn’t have to go into debt because my college tuition cost about 6,000 dollars a semester. That’s cheap. Dirt cheap from what I hear in the good ole U.S.A.

      U SUCK ASS USA. Fucking hate this planet. It’s not that complex, this world is just full of asshats.

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Brenda Walker, MA

Brenda Walker, MA, holds a Master of Arts Degree in Health Care Administration from Ashford University, a Bachelor of Science Degree in Health Care Management from Anthem College, and an Associates in Applied Science, priority focus in Limited Scope X-Ray. She had over 10 years of experience and a member of the National Association of Independent Writers and Editors. Her primary focus, recently, has been on the continued roll-out of the ACA, Medicare, and Strategic Planning and Implementation for small and private health care entities.
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