2013 CPT Code Changes Overview

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2013 CPT Code Changes Overview

Carol Storch & Heather Grube

Overview

• 2012 vs. 2013 behavioral health codes– What’s new in 2013

– What’s been deleted in 2013

• What’s changed about reporting location of services rendered• What’s changed about time

– Determining what code to use when your time is somewhere in between the definitions

– What does “face-to-face” mean now?

• What remains the same– Evaluation and Management definitions and documentation

requirements are the same

– Prescribers have always been eligible to use E&M codes

Please Note: This information is presented for educational purposes only, according to our understanding of available information, and is not meant as a directive to the viewer. 3

Contact information

Carol StorchPractice Management Services

(888) 774-0532www.valant.com

Heather GrubeDirector of Billing(888) 774-0532

www.valant.com

Vālant Medical Solutions #ValantCPT

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About Vālant

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• Founded in 2005

• Developed by Behavioral Heath Professionals

• 1000+ Daily Behavioral Health Clinicians Using

• Certified for Meaningful Use

• Attestations & Payments Received From 2011!

Vālant’s EMR for Behavioral Health

Sales: sales@valantmed.com

Let’s Begin!!!

First steps

• Order AMA 2013 CPT** book– AMA https://catalog.ama-assn.org/Catalog/product/product_detail.jsp?productId=prod1990006

– APA http://www.apa.org/

– AAPC http://www.aapc.com/

• CMS Evaluation and Management Services Guide. This contains the 1995 and 1997 Documentation Guidelines for Evaluation and Management Services, two of three main parts of your E&M resource base

– http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/eval_mgmt_serv_guide-ICN006764.pdf

• Contact your payers

*Current Procedural Terminology (CPT®) copyright 2012 American Medical Association.

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2012 deleted codes

Outpatient Therapy Codes

Outpatient Interactive Psychotherapy

InpatientPsychotherapy

InpatientInteractivePsychotherapy

Pharmacologic Management

90801 90810 90816 90823 90862

90802 90811 90817 90824

90804 90812 90818 90826

90805 90813 90819 90827

90806 90814 90821 90828

90807 90815 90822 90829

90808

90809

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New codes for 2013

Diagnostic Assessment

Psychotherapy Psychotherapy with E/M

Other Psychotherapy

Pharmacologic Management

90791 90832 90833 + E/M 90839 E/M code

90792 90834 90836 + E/M 90840 90863**

90837 90838+ E/M 90785

**for therapists eligible to prescribe in LA and NM.

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1:1 Crosswalk for Psychotherapy

2012 2013

90801 – initial psychiatric assessment 90791 – initial psychiatric assessment

90802 – interactive initial assessment 90791 + 90785

90804 – 20-30 min therapy session 90832 – 30 min

90806 – 45-50 min therapy session 90834 – 45 min

90808 – 75-80 min therapy session 90837 – 60 min

These are the Psychotherapy CPT codes for non-prescribers10

2013 Psychotherapy and Time

Code Defined TimeTime values used to

determine code

90832 30 minutes 16-37 minutes

90834 45 minutes 38-52 minutes

90837 60 minutes 53+ minutes

CPT Time Rule will be used to determine the appropriate CPT code for the session. Think of the 15 minute time block between time definitions; anything 7 minutes or less will be “rounded down” and anything 8 minutes or greater will be “rounded up.”

New definition of face-to-face time ‘Psychotherapy times are for face-to-face services with patient and/or family members. Patients must be present for all or some of the service’.*

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2013 Interactive Complexity

In 2012 there were designated CPT codes for interactive complexity asdetermined by time

In 2013 interactive complexity is a single code which can be added onto any therapy code

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90785 ‘interactive complexity (list separately in addition to the primary procedure code)’*

Place of Service

In 2012 the therapy code definitions included Place Of Service (POS)

In 2013 there is one list of therapy codes and location is reported usingthe POS code as it would correspond to box 24b on the CMS-1500form

2012 2013

90816 – 20-30 min inpatient therapy 90832 – 30 min therapy with POS 21

90823 – 20-30 min interactive IP therapy 90832 + 90785 – 30 min interactive therapy with POS 21

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1:1 Crosswalk Psychotherapy with E/M

2012 2013 (E/M code)

Any of the followingInteractive

Complexity

9080590807 90809POS 11, 22, etc.

Appropriate E/M code(99201-99215)

9083330 min therapy

9081190813 90815POS 11, 22, etc.

Appropriate E/M code(99201-99215)

9083645 min therapy

90785

9081790819 90822POS 21

Appropriate E/M code(99218-99239)

9083860 min therapy

9082490827 90829POS 21

Appropriate E/M code(99218-99239)

90785

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E/M codes

All duly, appropriately licensed providers of any specialty have alwaysbeen eligible to use E/M codes

Most typical E/M codes used are 99201-99205 and 99211-99215

The 1997 Evaluation and Management Services Guidelines outline therequirements for a psychiatric examination with clearly defined bulletpoints that can be easily counted to determine the level of examination.One of the bullet points is the mental status exam, already usedregularly by psychiatrists.

– https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Downloads/97Docguidelines.pdf

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Choosing the Appropriate E/M

E/M documentation requirements are unchanged

Two ways to choose the level of E/M1. Counseling and coordination of care consideration where >50% of total

time in session is devoted to counseling and coordination of care with patient/ caregivers (in this description, counseling does not mean therapy)

• Time is considered the key factor ~i.e. you must note the start and end time of the entire session and carefully note how much time is devoted to counseling and/or coordination of care. Documentation should explicitly describe the plan of care.

2. Based on 3 key components (history, exam, and medical decision making) of 7 elements. Many educational resources exist for E/M coding. Your 2013 CPT guidebook and the 1997 CMS publication are the place to start.

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Outpatient Therapy with E/M

2012 2013 (E/M code) Any of the following

9080590807 90809

Appropriate E/M code(99201-99215)

90833 – 30 min therapy90836 – 45 min therapy90838 – 60 min therapy

In 2012 therapy with medical evaluation and management services was reported by a single code based on face-to-face time

In 2013 therapy with medical evaluation and management services can only be reported as an add-on code to the appropriate E/M code

If time is your controlling factor for determining E/M code (counseling and coordination of care consideration) you may not bill a therapy add-on code

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2013 Psychotherapy with E/M and Time

Code Defined TimeTime values used to determine therapy

code

90833 30 minutes 16-37 minutes

90836 45 minutes 38-52 minutes

90838 60 minutes 53+ minutes

All therapy codes on this page are add-on codes that must be usewith the appropriate E/M code

Time spent on E/M is separate from time spent in therapy

E/M codes billed with therapy add-on codes must be chosenaccording to medical complexity, history and the exam. They are notbased on the amount of time spent on the E/M portion of service.

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E/M and Therapy example

9:00AM 9:45AM

Appropriate E/M code 90833 – 30 min

90836 – 45 min

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E/M and Therapy example

11:00AM 11:30AM

Appropriate E/M code

90833 – 30 min

Do not report psychotherapy of <16 minutes 20

Psychotherapy for Crisis

New category in 2013

Do not report psychotherapy for crisis of less than 30 minutes total duration

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90839 first 60 minutes

+90840 each additional 30 minutes

Pharmacologic Management

90862 is no more !!

To report pharmacologic management, you must use the appropriate E/Mcode based on medical complexity or time

You might find the E/M code falls in the middle of 99211-99215 when choosingthe appropriate code for medication management only (no therapy timecalculated)

99212 - need 2 of 3 99213 – need 2 of 3

Problem focused history Expanded problem-focused history

Problem focused exam Expanded problem-focused examination

Straightforward medical decision making

Medical decision making of low complexity 22

3 things to do now!

1. Order 2013 CPT book

2. Review or learn how to use E/M coding and the documentation requirements

3. Contact your payers and ask if the E/M codes you are likely to bill are included in your contract, and ask for fee schedules for the new 2013 codes

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Resources

• Order AMA 2013 CPT** book– AMA https://catalog.ama-assn.org/Catalog/product/product_detail.jsp?productId=prod1990006

– APA http://www.apa.org/

– AAPC http://www.aapc.com/

• CMS Evaluation and Management Services Guide. This contains the 1995 and 1997 Documentation Guidelines for Evaluation and Management Services, two of three main parts of your E&M resource base

– http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/eval_mgmt_serv_guide-ICN006764.pdf

– https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Downloads/97Docguidelines.pdf

• Your local, state, and national associations

• CMS.gov– Medicare Learning Network: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-

Network-MLN/MLNGenInfo/index.html

**Current Procedural Terminology (CPT®) copyright 2012 American Medical Association.

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Q/A

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