THE NEW CPT CODES - cdn.ymaws.com€¦ · •Medicare will pay for conjoint marital or family...
Transcript of THE NEW CPT CODES - cdn.ymaws.com€¦ · •Medicare will pay for conjoint marital or family...
Sponsored byNASW-MA Chapter’s
Social Work Therapy Referral Service (SWTRS)
Presented byErica Kirsners, LICSW
THE NEW CPT CODES:WHAT THEY ARE
AND HOW TO USE THEM
CPT copyright 2012. American Medical Association.All rights reserved. CPT is a registered trademark of the American
Medical Association.
Crosswalk of Most Frequently Used CPT Codes
2012 CODE 2013 CODE ADDITIONAL INFORMATION
ADD-ON CODE(For Interactive
Complexity)
90801 90791 Diagnostic Evaluation
90804 90832 (30 min) Actually 16-37 min 90785 (when appropriate)
90806 90834 (45 min) Actually 38-52 min 90785 (when appropriate)
90847 No Change Family Therapy Conjoint, With Patient
90853 No Change Group Therapy (other than multiple-family group)
Basic Differences & Changes•Some codes have simply been changed•For example, what was 90801, initial evaluation, is now 90791
•Some codes have not changed•For example, family therapy with the patient, 90847, remains unchanged
Basic Differences & Changes•2012 codes which have changed
•Psychotherapy codes based on amount of time spent in interview
•Initial diagnostic evaluation codes•Interactive codes
Basic Differences & Changes•Modifier (“add-on codes”)
• Indicates increased interactive complexity of the intervention
•Used ONLY in conjunction with a primary code for evaluation, psychotherapy, or group therapy
•Never used as stand-alone codes
Interactive Complexity•CPT Manual has specific guidelines•Examples include:
• Play therapy with young children• Managing maladaptive communications or interactions between patient and family
• Discussing an event that requires a mandated report
Interactive Therapy•There is no longer a separate code for interactive therapy
•Now indicated by the add-on code (90785) for interactive complexity
New Codes for Crisis Intervention• Involve situations which require immediate intervention and include• Urgent assessment• History of the crisis state• Mental status exam• Disposition (mobilization of resources, interventions to minimize crisis and restore safety)
No Site-of-Service Differential•There is NO differentiation based on setting• i.e. WHERE a service takes place• In-office codes are the SAME as inpatient codes for the SAME service
No Grace Period•Use of new codes is based on Date of Service (DOS), NOT on date of submission of claim• All DOS before 1/1/13 must us OLD CPT codes
• All DOS after 1/1/13 must use NEW CPT codes
• Continue to follow ALL filing/billing rules for each insurance company
Crosswalk of 2013 CPT Codes2012 CODE 2013 CODE ADDITIONAL
INFORMATIONADD-ON CODE(For Interactive
Complexity)
90801 90791 Diagnostic Evaluation
90802 90791 Interactive Diagnostic Evaluation
90785
Diagnostic Evaluation• There is only one code to be used for evaluation: 90791
• To indicate interactive diagnostic evaluation, use 90791 and add-on code 90785
• Diagnostic evaluation code can be billed more than once:• When conducted on separate days• When separate evaluations are conducted with patient and other informants
Interactive Complexity• Play therapy with young children• Use of translator or interpreter
• Medicare will not pay for this• To manage maladaptive communication that complicates delivery of care
• When the patient’s family behavior interferes with treatment plan
• When one must discuss a sentinel event that requires a mandated report
Crosswalk of 2013 CPT Codes2012 CODE 2013 CODE ADDITIONAL
INFORMATIONADD-ON CODE(For Interactive
Complexity)
90804 90832 (30 min) Actually 16-37 min 90785 (when appropriate)
90806 90834 (45 min) Actually 38-52 min 90785 (when appropriate)
90808 90837 (60 min) Actually 53+ min 90785 (when appropriate)
Psychotherapy• Use the shorter code, now 90832, for half sessions
• Use intermediate code, 90834, for regular 45-50 minute sessions
• Thus, 90834 will be our new STANDARD “50 minute hour”
• 90806 was for “individual therapy”• 90834 is now for “psychotherapy with patient and/or family member”
Psychotherapy• Few MCOs have actually paid in the past for 90808• Therefore do not bill 90837
• Bill the Crisis Code if it is a crisis• 90839 (60 min.) and 90840 (each additional 30 min.)
• If patient is in crisis and it is clinically indicated to extend the session
• AND work fits the criteria for crisis
Crosswalk of 2013 CPT Codes2012 CODE 2013 CODE ADDITIONAL
INFORMATIONADD-ON CODE(For Interactive
Complexity)
90810 (interactive)
90832 (30 min) Actually 16-37 min 90785
90812 (interactive)
90834 (45 min) Actually 38-52 min 90785
90814 (interactive)
90837 (60 min) Actually 53+ min 90785
Crosswalk of 2013 CPT Codes2012 CODE 2013 CODE ADDITIONAL
INFORMATIONADD-ON CODE(For Interactive
Complexity)
90816 (inpatient)
90832 (30 min) Actually 16-37 min 90785 (when appropriate)
90818 (inpatient)
90834 (45 min) Actually 38-52 min 90785 (when appropriate)
90821 (inpatient)
90837 (60 min) Actually 53+ min 90785 (when appropriate)
Inpatient & Facilities•Services provided in a facility NO LONGER have a separate code
•Facility refers to inpatient psychiatric unit, partial hospitalization program, residential facility
Crosswalk of 2013 CPT Codes2012 CODE 2013 CODE ADDITIONAL
INFORMATIONADD-ON CODE(For Interactive
Complexity)
No Existing Code
90839 Psychotherapy for Crisis –60 min (actually 30-74 min)
No existing Code
90839 Psychotherapy for Crisis –each additional 30 min
90840
• A crisis involves a situation which requires immediate attention for a life threatening situation, and includes:• Urgent Assessment• History of crisis• Mental status exam• Disposition (mobilization of resources, interventions to diffuse
crisis, restore safety and minimize psychological trauma)
Crosswalk of 2013 CPT Codes2012 CODE 2013 CODE ADDITIONAL
INFORMATIONADD-ON CODE(For Interactive
Complexity)
90857 90853 (with add-on)
Interactive Group Therapy 90785
Crosswalk of 2013 CPT Codes2012 CODE 2013 CODE ADDITIONAL
INFORMATIONADD-ON CODE(For Interactive
Complexity)90845 No Change Psychoanalysis
90846 No Change Family Therapy Without Patient
90847 No Change Family Therapy Conjoint, With Patient
90849 No Change Multiple-family Group Psychotherapy
90853 No Change Group Therapy (other than multiple-family group)
90880 No Change Hypnotherapy
90889 No Change Preparation of report of patient’s psychiatric status, history, treatment, or progress (other than for legal or consultative purposes) for other therapists, physicians, or insurance carriers
Medicare Payment for Conjoint Family Therapy
• Medicare will pay for conjoint marital or family therapy ONLY when primary purpose is treatment of patient’s condition• To observe patient’s interaction with family members
• To assess the capability of, and assist family members in aiding in, management of patient
Preliminary Rates•Not determined yet• Probably:
• 90791 (evaluation) will pay same as 90801
• 90834 (38 – 52 minutes; “50 minute hour”) will be the same as 90806
• Each insurance company will determine rates for 90839 & 90840
Authorizations• Magellan states new code will require authorization if it was mapped from an old code that required one. Auths already in place will cross over into 2013
• New crisis codes will require authorization, probably by phone (not on-line)
• Not yet determined if new add-on code will need authorization