Get Ready for E&M Coding, Experts Advise

Previously, the key intake code was 90801 and could be used when intake was done by a social worker, or a geriatric psychiatrist or a nurse practitioner. The argument was made that the level of work is different among those providers, Dr. Burd said. In recognition of that, in 2013 two intake codes will be available: 90792 for medical services, and 90791 for nonmedical services.

The psychiatric diagnostic evaluation code can be used in any setting, inpatient or outpatient. And it can be used more than once; if an evaluation spans several appointments, the code can be used for reassessments, Dr. Burd said.

In 2013, more psychiatric services will now be covered by E&M codes. Currently, E&M codes are used for psychotherapy, as these services are time based. For example, a psychiatrist can bill for 20-30 minutes of face-to-face contact, which would be mostly psychotherapy, and there would be a small amount of E&M involved, Dr. Burd said.

In the coming year, the situation is reversed. The psychiatrist will specify the level of E&M work done during the patient appointment and then add on codes for psychotherapy work, he said. Using a specific E&M will allow for greater accuracy for physician work during that time. Those codes require documenting the patient’s history, the exam, and the physician’s decision making for the E&M portion of the visit, with the psychotherapy component based on the time spent delivering psychotherapy.

It’s a bit ironic that in an era of bundling of services, there is unbundling for psychiatry – physicians will submit two codes for services that previously had a single value, Dr. Burd pointed out.

New codes also are available for crisis psychotherapy. The base code of 90839 will be used for the initial contact; the add-on code of 90840 will be available for every additional 30-minute increment.

Finally, the Current Procedural Terminology (CPT) eliminated a parallel set of codes that existed for interactive services such as play therapy or e-mailing patients, Dr. Burd said. Instead, "the modifier 90785 can be added to pretty much any code."

If a psychiatrist previously billed a 90802 as an intake with interaction, "I’d now bill at 90792 or 91 plus the interactive code of 90875," he said.

For psychiatrists trying to get up to speed, the APA conducts webinar "train the trainer" sessions so that psychiatrists can help bring local colleagues up to speed, Dr. Musher said. He also will present the new codes at the AMA’s annual CPT symposium for coders from physician practices. Subspecialty groups such as the American Association for Geriatric Psychiatry also will hold webinars.

The APA is set to provide documentation templates to members via its website. And the organization is working with payers to ensure they have a uniform interpretation of the new codes and that their systems will be set up to understand the new codes, Dr. Burd said.

He urged psychiatrists to educate themselves, starting by getting a copy of the CPT for 2013 and reading it, especially the section on E&M codes, he said.

Long term, there’s an upside for psychiatrists, Dr. Burd said. Many have been locked into low-value contracts, he noted. By using higher-level codes, "they’ll be able to bill for higher-level service."