Question for Psych NPs/CNSs about 2013 code changes

michaelsam · Dec 24, 2012

ok, so here is what I know, new codes are effective Jan 1st, all other deleted codes will generate a claim denial. I have been doing a lot of searching and reading and it still is very confusing. There is some information available on the child and adol psychiatry website in the form of tutorials and an algorithm for choosing codes, but The choice of codes appears very difficult and at least UnitedHealthCare has not allowed some codes to be used because of its higher reimbursement. The big question is if you do 45 min of psychotherapy and it involves E/M of medication is this NECESSARILY a prim code with an add on code? but if you use a single code like 90836, then the reimbursement will be lower than last year. It's a real mess. If we can start a discussion, maybe we can figure it out.

myelin · Dec 25, 2012

yikes, sounds so confusing. Thanks for your response. It will be interesting to see how this plays out and if the insurance companies will really raise reimbursement rates.

Ellen NP, MSN, NP · Dec 30, 2012

We will absolutely be using the new codes. You'll need to be very aware of documentation to substantiate codes. Other specialties have been using E/M codes for ages. There are algorithms available for coding but you really need to talk with someone who does/teaches coding to get a real feel for it. My practice is 100% inpatient some the impact for me as an acute care clinician is less than for oupt people who are doing therapy. Are you in a group practice or independent? If you're with a group, ask for guidance, templates for documentation, etc.

myelin · Dec 30, 2012

Do you think it will make a substantial difference in reimbursement or income?

Ellen NP, MSN, NP · Dec 30, 2012

It could go either way. If you really take credit for all that you do you can code up for the higher services. If you don't document well you could lose. It looks as if the outpt world will have to be very clear in how they schedule, conduct and code services. For me, I can now find ways to take credit for stuff that I couldn't bill for in the old system. I just need to add a bit and I can add on for supportive therapy. I can bill for my phone consults and collateral contacts in ways that I couldn't before. The documentation will be the decision maker.

myelin · Dec 31, 2012

Very interesting. Yes, it sounds like psychiatric providers are now able to bill like medical providers and can potentially bill for more, given they are careful about documentation. Thank you for your clarification, I really appreciate it.

priorities2 · Jan 5, 2013

I spoke with a psychiatrist about the code changes. He said that since psychiatrists formulate the codes, the purpose of the code change is to increase their reimbursement. Psych NPs code like psychiatrists and therefore are also meant to benefit from the change. The code change is written so that other kinds of therapists won't see an increase in reimbursement, so it might be bad for them. However, he also insisted that we won't know how the code changes play out for a while. He didn't elaborate much on why that is.