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Significant changes in coding and billing for almost all psychiatric services will come into being from January 1, 2013. The new changes may require considerable modifications to the billing processes, practice management systems and workflow of behavioral health agencies.

Changes to the Psychiatry Code Set

  • The E&M codes plus psychotherapy codes (90805, 90807) have been removed from the psychiatry section.
  • Pharmacologic management code has been deleted; providers have to use the appropriate E&M code.
  • Add-on codes have been introduced for psychiatry, for services performed other than a primary service or procedure, and never as a stand-alone procedure.
  • E&M services and psychotherapy services have been distinguished from each other. The time spent for E&M cannot be counted along with that for psychotherapeutic services. Separate codes can be used in combination with one another.
  • Interactive complexity code 90785 has been added.
  • A new code has been added for psychotherapy to report a patient in crisis.

Regarding the New Codes

Though all mental health providers have to use the new CPT codes for psychotherapy from January 1, the fundamental services represented by these codes will not change. The Medicare reimbursement rates for the new codes are expected to be released in November 2012.

  • Code 90806  (45-50 minute psychotherapy) will become 90834 (45-minute psychotherapy)
  • Code and reimbursement for a particular psychotherapy service will not differ irrespective of whether the service is provided by a physician or a psychologist.
  • There is no change in the code numbers and descriptions for family psychotherapy (with or without the patient), psychoanalysis, group psychotherapy and multi-family group psychotherapy.
  • A single set of codes will replace the inpatient and outpatient psychotherapy codes, and can be used in both settings.
  • Two codes, one for diagnostic evaluation and another for diagnostic evaluation with medical services, will replace the single psychiatric diagnostic evaluation code.
  • The new psychotherapy codes will have specified times instead of ranges:
    • 30 minutes, not 20-30 minutes
    • 45 minutes, not 45-50 minutes
    • 60 minutes, not 75-80 minutes

Rajeev Rajagopal

Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.

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