JEREMY S. MUSHER, MD, DFAPA
PRESIDENT AND CEO
MUSHER GROUP, LLC
MUSHERGROUP.COM
APA Advisor, AMA/Specialty Society RVS Update Committee (RUC)
APA CPT Alternate Advisor
Musher Group, LLC © 2012
Disclaimer
The opinions referenced are those of the Musher Group,
LLC based on their coding experience. They are based
on the commonly used codes in Psychiatry, which are not
all inclusive. Always check with your local insurance
carriers as policies vary by region. The final decision for
the coding of a procedure must be made by the physician
considering regulations of insurance carriers and any
local, state or federal laws that apply to the physician’s
practice. The Musher Group, LLC and its representatives
disclaim any liability arising from the use of these
opinions.
Hurry and Get Ready!
New Codes are Coming!!
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
1
PSYCHIATRY
Family of Codes
has been Revised
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
2
•
Codes are NO LONGER
SITE SPECIFIC
•
Psychotherapy in an
inpatient, office, or
nursing home setting
will have the SAME
CPT Code
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
3
Psychiatric Diagnostic
Services
(Replaces 90801 and 90802)
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
4
•
90791 Psychiatric Diagnostic Evaluation
•
90792 Psychiatric Diagnostic Evaluation
with medical services
•
Both include History, Mental Status
Exam, Recommendations, Ordering
of Diagnostic Studies
•
90792 additionally includes medical
assessment, which may include, as
indicated, vital signs, gait and
station or muscle strength and tone,
etc.; review and ordering of
laboratory and other diagnostic
studies
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
5
•
For Both Codes (90791 and 90792)
•
One or more informants may be seen
in lieu of the patient
•
May be reported more than once
when separate evaluations are
conducted with patient and
informant(s)
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
6
•
HOW WILL WE
CAPTURE
“INTERACTIVE” ?
•
(e.g. 90802)
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
7
•
NEW CODE USE FOR PSYCHIATRY:
•
Add On Code:
•
A code that describes the work that is
performed in addition to the primary
service
•
It is never reported alone
•
Two or more codes billed:
Primary and Add On(s)
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
8
Interactive
Complexity (+90785)
•
Examples of previous “Interactive”
Codes:
•
90802 Interactive Psychiatric
Diagnostic Evaluation
•
90810 Interactive Psychotherapy, 2030 mins
•
90811 Interactive Psychotherapy with
E/M, 20-30 mins
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
9
•
“Interactive” in previous
codes was limited in use to
times when physical aids,
translators, interpreters,
and play therapy was used
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
10
“Interactive Complexity” extends the use to
include other factors that complicate the
delivery of a service to a patient. These
include:
•
•
Arguing or emotional family members in a
session that interfere with providing the
service
•
Third party involvement with the patient,
including parents, guardians, courts,
schools, that interferes with providing
the service
•
Need for mandatory reporting of a sentinel
event with discussion in the session
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
11
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
12
•
How will we bill for
Medication Management
?
•
(e.g. 90862)
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
13
90862
Pharmacologic
Management
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
14
•
90862 Pharmacologic Management has
been ELIMINATED
•
E/M codes will be used
•
New code 90863 will be used by
qualified psychologists with
prescriptive authority in some
jurisdictions.
•
PHYSICIANS AND ADVANCED
PRACTICE NURSES SHOULD
NEVER USE 90863
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
15
Pharmacologic Management
(Pre and Post 2013)
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
16
Psychotherapy
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
17
Psychotherapy service codes remain time
based.
•
•
The patient must be present for all or some of
the service (may include family members or
others in the treatment process)
•
When reported alone, they will be coded as 30,
45, or 60 minutes (90832, 90834, 90837)
•
When reported with an E/M service by a
qualified practitioner they will be coded as an
Add On Code for 30, 45,or 60 minutes(+90833,
+90836, +90838)
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
18
CPT Time Rule
“A unit of time is attained when the midpoint is passed”
“When codes are ranked in sequential
typical times and the actual time is
between two typical times, the code
with the typical time closest to the
actual time is used.”
As an example, codes of 30, 45, and 60
minutes are billed at 16-37 mins, 3852 mins, and 53-67 mins.
(CPT 2013, p xii)
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
19
•
When reporting an E/M service with an Add On
Psychotherapy service (+90833, +90836, +90838)
•
The E/M service is selected first (type and level)
•
Level based on Elements, CANNOT use
Time (Counseling and Coordination of Care)
•
Time devoted to meeting the requirements of the
E/M service cannot be used for the
psychotherapy time
•
A separate diagnosis is not needed for the reporting
of the psychotherapy and E/M on the same date of
service
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
20
The Psychotherapy Add-On Codes can
be billed with the following primary E/M
Codes:
•
Outpatient, established patient:
•
•
99212-99215
Subsequent hospital care
•
•
99231-99233
Subsequent nursing facility care
•
•
99307-99310
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
21
Psychotherapy:
Pre and Post 2013
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
22
Psychotherapy with E/M
Pre and post 2013
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
23
Putting it all together:
Psychotherapy with Interactive Complexity
(Can potentially bill 2 codes: E/M +Interactive Complexity Add
On)
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
24
Putting it all together:
E/M with Psychotherapy and Interactive Complexity
(Can potentially bill 3 codes: E/M +Psychotherapy Add On +
Interactive Complexity Add On)
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
25
+90785 “with interactive complexity” Add On code
may be used with:
•
•
•
Diagnostic Codes (90791, 90792),
•
Psychotherapy Codes (90832, 90834, 90837),
•
Group psychotherapy (90853)
•
As a second Add On code if a psychotherapy Add
On code (90833, 90836, 90838) is used with an
E/M Code
90785 may not be used with the Crisis Codes
(90839, +90840)
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
26
Other Psychotherapy
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
27
Crisis Psychotherapy
•
Two new codes (90839, +90840) to be
used when the presenting problem is
“life threatening or complex and
requires immediate attention to a
patient in high distress”
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
28
•
90839 Psychotherapy for crisis, first 60
minutes
•
ADD ON CODE: +90840 each
additional 30 minutes (list separately in
addition to code for primary service)
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
29
•
These codes are time based and include
time face to face with the patient and/or
family.
•
The time does not have to be continuous,
but must involve the full attention of the
physician or other qualified healthcare
professional to the patient and or family
member.
•
Services cannot be provided to any other
patient during the time period billed under
these codes
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
30
•
90839 is used to report the first 30-74
minutes of psychotherapy for crisis
•
ADD ON CODE +90840 should be
reported for each additional 16-45
minutes
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
31
•
RECAP:
•
2 New Diagnostic Evaluation Codes:
•
90791 (No medical services)
•
90792 (With medical services)
•
90862 Eliminated - Physicians and APRNs USE E/M
•
Psychotherapy Codes
•
Stand-Alone -
•
Add-On with E/M
•
CPT TIME RULE
•
30 mins (16-37) 45 mins (38-52) 60 mins (53-67)
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
90832, 90834, 90837
- 90833, 90836, 90838
32
•
RECAP:
•
Add On Codes will be used for certain services:
•
Interactive Complexity
•
Psychotherapy Services when combined with E/M services
•
Crisis Psychotherapy Add On for each additional 30 minutes
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
33
•
HOW TO PREPARE
•
Purchase a 2013 edition of the AMA CPT manual at
www.amabookstore.com
•
Learn how to select & document E/M codes (99xxx series)
•
Check out the Training sessions with
documentation templates at MusherGroup.com
•
Locate and review any contracts with commercial payers
and Medicaid
•
Watch the APA website for more information
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
34
In case of emergency,
meditate like hell!!
Copyright ©2012 Musher Group, LLC. All Rights Reserved.
35