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CPT Webinar 11.19.12

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Introduction to 2013 CPT Code Changes Webinar Slides-
Valant covers the expected 2013 CPT Code changes for behavorioal health billing. Slides include resources and lionks

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CPT Webinar 11.19.12

  1. 1. 2013 CPT Code Changes OverviewOur Webinar will start at 10:00 AM (PST)
  2. 2. 2013 CPT Code Changes Overview Carol Storch & Heather Grube
  3. 3. 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
  4. 4. Contact information Vālant Medical Solutions #ValantCPT Carol Storch Heather GrubePractice Management Services Director of Billing (888) 774-0532 (888) 774-0532 www.valant.com www.valant.com 4
  5. 5. About VālantVālant’s EMR for Behavioral Health• Founded in 2005• Developed by Behavioral Heath Professionals• 1000+ Daily Behavioral Health Clinicians Using• Certified for Meaningful Use• Attestations & Payments Received From 2011! Sales: sales@valantmed.com 5
  6. 6. Let’s Begin!!!
  7. 7. 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_• Contact your payers*Current Procedural Terminology (CPT®) copyright 2012 American Medical Association. 7
  8. 8. 2012 deleted codesOutpatient Outpatient Inpatient Inpatient PharmacologicTherapy Codes Interactive Psychotherapy Interactive Management Psychotherapy Psychotherapy90801 90810 90816 90823 9086290802 90811 90817 9082490804 90812 90818 9082690805 90813 90819 9082790806 90814 90821 9082890807 90815 90822 908299080890809 8
  9. 9. New codes for 2013Diagnostic Psychotherapy Psychotherapy Other PharmacologicAssessment with E/M Psychotherapy Management90791 90832 90833 + E/M 90839 E/M code90792 90834 90836 + E/M 90840 90863** 90837 90838+ E/M 90785 **for therapists eligible to prescribe in LA and NM. 9
  10. 10. 1:1 Crosswalk for Psychotherapy 2012 201390801 – initial psychiatric assessment 90791 – initial psychiatric assessment90802 – interactive initial assessment 90791 + 9078590804 – 20-30 min therapy session 90832 – 30 min90806 – 45-50 min therapy session 90834 – 45 min90808 – 75-80 min therapy session 90837 – 60 min These are the Psychotherapy CPT codes for non-prescribers 10
  11. 11. 2013 Psychotherapy and Time Time values used to Code Defined Time determine code 90832 30 minutes 16-37 minutes 90834 45 minutes 38-52 minutes 90837 60 minutes 53+ minutesCPT Time Rule will be used to determine the appropriate CPT code for thesession. Think of the 15 minute time block between time definitions; anything 7minutes or less will be “rounded down” and anything 8 minutes or greater willbe “rounded up.”New definition of face-to-face time‘Psychotherapy times are for face-to-face services with patient and/or familymembers. Patients must be present for all or some of the service’.* 11
  12. 12. 2013 Interactive Complexity ‘interactive complexity (list separately in 90785 addition to the primary procedure code)’*In 2012 there were designated CPT codes for interactive complexity asdetermined by timeIn 2013 interactive complexity is a single code which can be added onto any therapy code 12
  13. 13. Place of Service 2012 201390816 – 20-30 min inpatient therapy 90832 – 30 min therapy with POS 21 90832 + 90785 – 30 min interactive90823 – 20-30 min interactive IP therapy therapy with POS 21 In 2012 the therapy code definitions included Place Of Service (POS) In 2013 there is one list of therapy codes and location is reported using the POS code as it would correspond to box 24b on the CMS-1500 form 13
  14. 14. 1:1 Crosswalk Psychotherapy with E/M 2012 2013 Interactive (E/M code) Any of the following Complexity9080590807 Appropriate E/M code 9083390809 (99201-99215) 30 min therapyPOS 11, 22, etc.9081190813 Appropriate E/M code 90836 9078590815 (99201-99215) 45 min therapyPOS 11, 22, etc.9081790819 Appropriate E/M code 9083890822 (99218-99239) 60 min therapyPOS 219082490827 Appropriate E/M code 9078590829 (99218-99239)POS 21 14
  15. 15. E/M codesAll duly, appropriately licensed providers of any specialty have alwaysbeen eligible to use E/M codesMost typical E/M codes used are 99201-99205 and 99211-99215The 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/MLNEdWebGu 15
  16. 16. Choosing the Appropriate E/ME/M documentation requirements are unchangedTwo ways to choose the level of E/M 1. 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. 16
  17. 17. Outpatient Therapy with E/M 2012 2013 (E/M code) Any of the following90805 90833 – 30 min therapy Appropriate E/M code90807 90836 – 45 min therapy (99201-99215)90809 90838 – 60 min therapyIn 2012 therapy with medical evaluation and management services wasreported by a single code based on face-to-face timeIn 2013 therapy with medical evaluation and management services canonly be reported as an add-on code to the appropriate E/M codeIf time is your controlling factor for determining E/M code (counselingand coordination of care consideration) you may not bill a therapy add-on code 17
  18. 18. 2013 Psychotherapy with E/M and Time Time values used to Code Defined Time determine therapy code90833 30 minutes 16-37 minutes90836 45 minutes 38-52 minutes90838 60 minutes 53+ minutes All therapy codes on this page are add-on codes that must be use with 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 chosen according to medical complexity, history and the exam. They are not based on the amount of time spent on the E/M portion of service. 18
  19. 19. E/M and Therapy example9:00AM 9:45AM Appropriate E/M code 90833 – 30 min 90836 – 45 min 19
  20. 20. E/M and Therapy example11:00AM 11:30AM Appropriate E/M code 90833 – 30 min Do not report psychotherapy of <16 minutes 20
  21. 21. Psychotherapy for Crisis 90839 first 60 minutes +90840 each additional 30 minutesNew category in 2013Do not report psychotherapy for crisis of less than 30 minutes totalduration 21
  22. 22. Pharmacologic Management 90862 is no more !!To report pharmacologic management, you must use the appropriate E/Mcode based on medical complexity or timeYou 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 Medical decision making of decision making low complexity 22
  23. 23. 3 things to do now!1. Order 2013 CPT book2. Review or learn how to use E/M coding and the documentation requirements3. 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 23
  24. 24. 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. 24
  25. 25. Q/A Q/ASubmit questions using the text tool on your screen

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