Warning: tongue-in-cheek alert
The executive director of our district branch sent out an email: New CPT Codes are Coming. Read more on the APA’s website! At first I ignored it – after all, coding is boring. Eventually, though, I clicked through to the APA’s website, and in order to read the information, I had to log in. Log in? I didn’t remember my APA username or password and I went to click on “Forgot your username?” and was told I needed to call the APA. Call? Like on a telephone? Here was the first sign that this was not going to be a smooth process.
I found my log in details, and I didn’t have to call. A good omen, I decided, and I proceeded to read through the APA slide show about the new CPT codes. 90801, soon gone, would now be 90792. I assumed that as a physician, I should use the code that included “with medical services,” whatever that might mean. Since I only bill 90801, 90805, and 90807 in my private practice, this wasn’t looking so bad; in a manner of minutes, I had figured out one-third of my coding issues. I work at a clinic where my services are billed as 90862 for pharmacologic management, but I figured they would tell me what code to use for the soon-to-be defunct 90862.
It was downhill from there. I flipped through the slides quickly and realized that there was one set of psychotherapy codes if there were no medications involved, another if medications are involved, and I now had to learn to use the five levels of complexity for the dreaded Evaluation and Management (E/M) codes that I have successfully avoided for years. One appointment, two codes with many possible variations, more documentation, and the slides didn’t tell me exactly how to use the E/M codes. I Googled and Googled, and nothing got better. And then I decided that someday I would figure this out and be the one to write about it. That day has not yet come, and if you’re reading to find out how to use the new CPT codes, you can stop now and come back in a few weeks.
I called the man I think of as the “CPT god,” Dr. Chester W. Schmidt, or more officially, the Consultant to the Committee on Codes and Reimbursements. “The AMA CPT editorial panel insisted there be revisions because of the need to differentiate medical-psychiatric services from nonmedical psychological services,” Dr. Schmidt noted. “We jumped on the opportunity to revise the psychiatry codes to give our practitioners the opportunity to more flexibly capture the work we do and to improve reimbursement.”
Dr. Schmidt suggested I buy a manual on how to use E/M codes and noted, “There probably is not a way to make learning this easy.” The truth be told, I want a way for this to be easy.
From there, I went to Amazon.com to look for an Evaluation and Management manual. I figured I would buy a Kindle version so that I could read it on my computer and on my phone. Funny, but in a world where physicians are being told we must embrace e-prescribing and electronic medical records, Amazon does not sell a kindle version of the AMA’s CPT manual for 2013. For the moment, I decided to hold off on buying this 600-page volume. It’s single Amazon reviewer noted that it was printed on paper “comparable to Russian toilet paper” and something about this imagine was not appealing.
My fellow Shrink Rapper, Steve Daviss, knows more about CPT codes than I do. He sent an e-mail saying, “For E&M, ‘counseling’ is not psychotherapy, it is essentially education, telling them about med effects and side effects, educating about sleep hygiene, about diagnosis, about treatment options, stuff like that. Coordination would be things like calling the therapist, writing a letter to the PCP, getting a prior authorization for a med, arranging for admission.”
It was early on a Saturday morning, I had not yet had a single drop of coffee, and I e-mailed back a caustic response about how counseling and education get peppered throughout a psychotherapy session; one would have to sit with a stopwatch to account for how many minutes of each type of communication there are, and that this would be distracting to the process of patient care. It would require different fees for every session, which the patient would not know in advance, and I ended my rant by saying that perhaps I would opt out of Medicare and by the time I finished, I’d threatened to quit my clinic job and announced I’d be forced into commit billing fraud.