Problems with the 2013 Psychotherapy CPT Codes

February 14, 2013 in Managing Your Practice

Problems with 2013 psychotherapy CPT Codes

In just a little over a month since their implementation, the complaints about the new 2013 psychotherapy CPT codes are piling up. Mental health providers across the country are encountering a range of difficulties with the new coding. The new coding has had a significant effect on the clinical side of many provider’s practices as well as a profound financial impact. So what’s a therapist to do?

Here’s a snapshot of what I’m hearing about the implementation of the new 2013 psychotherapy CPT codes from the providers I work with:

Many insurance companies did not prepare their computer systems to accept the new codes beginning January 1, 2013.
This has resulted in confusion and payment delays for many providers. Although they submitted “clean” claims beginning at the first of the year, they’ve found that their claims have been “pended” by insurance companies. Across the country, many therapists have received no payment, other than copays, for the services they have provided since the beginning of the year because of these issues.

Some providers (and even larger practices) are now facing a very dire financial situation because their cashflow has effectively been squeezed down to a trickle. There are no laws or other recourse in place for providers caught in this payment bind. They must simply wait.

Some providers did not update their own billing systems to use the new codes in advance of the changes.
Insurers have rejected all of the 2013 claims they submitted using the 2012 CPT codes, resulting in processing and payment delays for these providers. Now these therapists are playing catch-up in updating their systems so they can submit compliant claims. Somehow, they didn’t hear, or simply didn’t heed the warning about the approaching coding changes.
 

There continues to be confusion and frustration over the application of some of the new coding, especially:

The elimination of the 90808 code
I have heard a great deal of angst over this change. For therapists and patients wanting to conduct a session lasting longer than 60 minutes, the new CPT codes have effectively closed the door to that option if insurance is involved. Unless the provider is willing to see the patient “for free” for any time over the 60 minute threshold, he or she must make the difficult decision to reduce session times to 60 minutes. There is no “replacement” code for 90808 per se. 90837 is the new code for a 60 minute session, but it will not allow providers to charge for additional time spent with the patient beyond the 60 minutes in the course of a normal psychotherapy session.

Crisis Codes
The definition of “crisis” for the new crisis codes has proven confusing for many providers. Some providers have even been tempted to use this coding as a way to extend the length of therapy sessions and get paid for it, which is not the intention of the code. Use caution in applying this code and be certain that you understand the definition of crisis.
 

Lessons from the 2013 CPT Code Transition

Be Prepared
As many of the practitioners I work with can attest to, being prepared financially for the unexpected in your practice has proven very important since January 1st of this year. Having a financial cushion set aside to help weather this kind of logistical storm is invaluable. I discussed setting aside reserve funds in my previous post: Prepare Your Practice for a Disaster, and it holds true for this kind of man-made disaster as well. In some markets, where most of the major payers have failed to pay providers since the beginning of the year, without savings to draw upon, many therapists would have had to close their doors. Make sure you build a financial cushion for your practice.

Be Informed
Its very easy to get focused on patients and the day-to-day grind of running a practice, but its important to stay in touch with changes in the laws and regulations governing the healthcare profession. Its never good to be surprised by a major change to coding or HIPAA laws or any of the myriad of other things that affect mental health practice. Being proactive and aware of upcoming changes allows you to make well-informed decisions on your time table with less stress and expense. Staying on top of changes doesn’t have to be overwhelming or overly time consuming. You can “keep your ear to the ground” for upcoming changes by:
 

  • Subscribing to the newsletter or other trade publication for your licensing body.
  •  

  • Subscribing to blogs, listservs or RSS feeds concerning issues of interest to mental health care providers.
  •  

  • The vendors that serve your practice such as your billing agency, software provider and even malpractice insurance provider may also provide useful information.
  •  

  • Asking other local providers how they are handling changes to laws and regulations. Your fellow therapists can be the source of valuable insights and resources.
  •  

     
    Speak Up
    In talking with providers, one consistent theme has come through since January 1st of this year- many of the changes to the 2013 CPT codes will have a negative impact on therapists’ ability to deliver quality patient care. The loss of longer sessions, the rate cuts associated with the new codes, the payment delays and a litany of other complaints have providers angrier and more vocal than I can ever recall about the mental health care insurance system as a whole.

    In many ways, the legacy of the 2013 coding changes may well be that it was the final straw for many providers who have quietly endured rate cuts and increasingly intrusive demands from insurers over the last couple decades. They will either leave the profession, leave private practice or stop accepting insurance if they are able. They are fed up with up with insurance company C.E.O.s dictating how they care for their patients while taking home million dollar bonuses- particularly in the last month or so while many of those therapists have gone virtually unpaid.

    If you feel that the 2013 psychotherapy CPT codes have negatively affected how you are able to deliver patient care, let your voice be heard:

  • Here is a link to an on-line petition to include insurance companies in anti-trust laws and reimburse providers at fair rates: Insurance companies & Congress: Reimburse clinicians fair wages and include insurance companies in anti trust law!

  •  

  • Contact the professional associations to which you belong and let them know you would like them to take action. Representatives from the major licensing bodies participated in the working groups that developed the new codes and should hear your feedback on how the coding is working “in the trenches.”
  •  

  • Contact your congressional representatives and let them know how these changes are negatively affecting patient care.
  •  

     

    For more information about the 2013 psychotherapy CPT Codes:

    American Medical Association website. Copies of the 2013 CPT® manual are available online at the AMA bookstore.

    CPT® is a registered trademark of the American Medical Association (AMA). CPT® five-digit codes, descriptions, and other data are copyright 2011 by the American Medical Association (AMA).
     
     

    Copyright © 2013 Real Psych Practice LLC