Get Ready for E&M Coding, Experts Advise

Psychiatrists are girding themselves for major changes in how they bill for their services starting Jan. 1, due to changes in the Current Procedural Terminology codes that were finalized in the 2013 Medicare Physician Fee Schedule.

The bottom line: Some psychiatrists, especially those who primarily do outpatient work, may have a steep learning curve with little additional payoff initially, according to Dr. Ronald Burd, chairman of the American Psychiatric Association committee on codes, RBRVS (Resource-Based Relative Value Scale), and reimbursement.

All psychiatrists will see increased pressure to start using evaluation and management (E&M) codes, which requires knowing the system and more documentation from the physician.

"If you’re used to using the E&M codes for inpatient work, it should translate pretty easily for outpatient work," said Dr. Jeremy S. Musher, who serves on the APA committee on codes, RBRVS, and reimbursement, and is the APA adviser to the American Medical Association (AMA) Relative Value Update Committee (RUC).

"But for psychiatrists who have not used E&M codes, there will be some learning involved in how to use, how to document, and how to bill," he said in an interview.

Reimbursement should eventually rise, but for the first year, the codes have been assigned interim values that aren’t much higher than current pay. Values may rise in 2014, after the professional societies have had a chance to survey psychiatrists on the new codes and the RUC looks at revaluing those codes, said Dr. Musher, medical director for psychiatric emergency services at the Western Psychiatric Institute and Clinic at the University of Pittsburgh Medical Center and president and CEO of the consulting company the Musher Group.

The goal of the coding changes is for all psychiatrists to have "the opportunity to be appropriately reimbursed for the intensity of the work they do," Dr. Burd, who is also inpatient medical director for Sanford Health Services in Fargo, N.D., said in an interview.

The coding revision has been in process for several years, according to Dr. Musher. All codes are reviewed and revised periodically. When some of the psychiatric codes came up for review, the APA and other mental health societies suggested that the codes be revised to pay psychiatrists more appropriately.

Since the last major revision of the codes in 1998, psychiatrists have been locked into an outpatient medication management code (90862) that pays a flat rate, he explained. But patients have become more complex, presenting with an increasing number of comorbidities. Patients are also more complicated from a psychiatric standpoint because many have been shifted from the inpatient to the outpatient environment, he said. "The payment structure we are operating under does not account for that," Dr. Musher said.

The new codes more accurately reflect what psychiatrists do, he said. Under the new system, the 90862 pharmacologic management code has been deleted. There is a 90863 code now, which was created for psychologists in states where they have prescriptive privileges. But these codes should not be used by psychiatrists or midlevel providers, according to Dr. Burd.

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."

Psychiatrists are girding themselves for major changes in how they bill for their services starting Jan. 1, due to changes in the Current Procedural Terminology codes that were finalized in the 2013 Medicare Physician Fee Schedule.

The bottom line: Some psychiatrists, especially those who primarily do outpatient work, may have a steep learning curve with little additional payoff initially, according to Dr. Ronald Burd, chairman of the American Psychiatric Association committee on codes, RBRVS (Resource-Based Relative Value Scale), and reimbursement.

All psychiatrists will see increased pressure to start using evaluation and management (E&M) codes, which requires knowing the system and more documentation from the physician.

"If you’re used to using the E&M codes for inpatient work, it should translate pretty easily for outpatient work," said Dr. Jeremy S. Musher, who serves on the APA committee on codes, RBRVS, and reimbursement, and is the APA adviser to the American Medical Association (AMA) Relative Value Update Committee (RUC).

"But for psychiatrists who have not used E&M codes, there will be some learning involved in how to use, how to document, and how to bill," he said in an interview.

Reimbursement should eventually rise, but for the first year, the codes have been assigned interim values that aren’t much higher than current pay. Values may rise in 2014, after the professional societies have had a chance to survey psychiatrists on the new codes and the RUC looks at revaluing those codes, said Dr. Musher, medical director for psychiatric emergency services at the Western Psychiatric Institute and Clinic at the University of Pittsburgh Medical Center and president and CEO of the consulting company the Musher Group.

The goal of the coding changes is for all psychiatrists to have "the opportunity to be appropriately reimbursed for the intensity of the work they do," Dr. Burd, who is also inpatient medical director for Sanford Health Services in Fargo, N.D., said in an interview.

The coding revision has been in process for several years, according to Dr. Musher. All codes are reviewed and revised periodically. When some of the psychiatric codes came up for review, the APA and other mental health societies suggested that the codes be revised to pay psychiatrists more appropriately.

Since the last major revision of the codes in 1998, psychiatrists have been locked into an outpatient medication management code (90862) that pays a flat rate, he explained. But patients have become more complex, presenting with an increasing number of comorbidities. Patients are also more complicated from a psychiatric standpoint because many have been shifted from the inpatient to the outpatient environment, he said. "The payment structure we are operating under does not account for that," Dr. Musher said.

The new codes more accurately reflect what psychiatrists do, he said. Under the new system, the 90862 pharmacologic management code has been deleted. There is a 90863 code now, which was created for psychologists in states where they have prescriptive privileges. But these codes should not be used by psychiatrists or midlevel providers, according to Dr. Burd.

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."

Psychiatrists are girding themselves for major changes in how they bill for their services starting Jan. 1, due to changes in the Current Procedural Terminology codes that were finalized in the 2013 Medicare Physician Fee Schedule.

The bottom line: Some psychiatrists, especially those who primarily do outpatient work, may have a steep learning curve with little additional payoff initially, according to Dr. Ronald Burd, chairman of the American Psychiatric Association committee on codes, RBRVS (Resource-Based Relative Value Scale), and reimbursement.

All psychiatrists will see increased pressure to start using evaluation and management (E&M) codes, which requires knowing the system and more documentation from the physician.

"If you’re used to using the E&M codes for inpatient work, it should translate pretty easily for outpatient work," said Dr. Jeremy S. Musher, who serves on the APA committee on codes, RBRVS, and reimbursement, and is the APA adviser to the American Medical Association (AMA) Relative Value Update Committee (RUC).

"But for psychiatrists who have not used E&M codes, there will be some learning involved in how to use, how to document, and how to bill," he said in an interview.

Reimbursement should eventually rise, but for the first year, the codes have been assigned interim values that aren’t much higher than current pay. Values may rise in 2014, after the professional societies have had a chance to survey psychiatrists on the new codes and the RUC looks at revaluing those codes, said Dr. Musher, medical director for psychiatric emergency services at the Western Psychiatric Institute and Clinic at the University of Pittsburgh Medical Center and president and CEO of the consulting company the Musher Group.

The goal of the coding changes is for all psychiatrists to have "the opportunity to be appropriately reimbursed for the intensity of the work they do," Dr. Burd, who is also inpatient medical director for Sanford Health Services in Fargo, N.D., said in an interview.

The coding revision has been in process for several years, according to Dr. Musher. All codes are reviewed and revised periodically. When some of the psychiatric codes came up for review, the APA and other mental health societies suggested that the codes be revised to pay psychiatrists more appropriately.

Since the last major revision of the codes in 1998, psychiatrists have been locked into an outpatient medication management code (90862) that pays a flat rate, he explained. But patients have become more complex, presenting with an increasing number of comorbidities. Patients are also more complicated from a psychiatric standpoint because many have been shifted from the inpatient to the outpatient environment, he said. "The payment structure we are operating under does not account for that," Dr. Musher said.

The new codes more accurately reflect what psychiatrists do, he said. Under the new system, the 90862 pharmacologic management code has been deleted. There is a 90863 code now, which was created for psychologists in states where they have prescriptive privileges. But these codes should not be used by psychiatrists or midlevel providers, according to Dr. Burd.

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."