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Behavioral Health: Out of the CPT Shadows

So these new CPT codes are pretty frustrating. This is going to be one more hurdle to justifying services and getting reimbursement. What’s more, we have a few short weeks to get on board and get moving. The old system seemed to be working well, so why are we changing it? I’m pretty fed up with it all. At least I was until I really began to understand it.

Before Thanksgiving I had the fortune of attending a training done by the American Psychiatric Association. There I was able to converse directly with colleagues who have been sitting on committees with Centers for Medicare and Medicaid Services and the American Medical Association for the past two years wrestling with these issues.

It seemed the goal was to bring mental health services up to date with the rest of medical services defined in the Common Procedural Terminology (CPT) codebook. This is the American Medical Association’s equivalent to psychiatry’s Diagnostic and Statistical Manual. CPT defines medical services (as it had for previous mental health services) and is largely adopted by all medical services and managed care in America. The changes in the CPT coding can be viewed as part of mental health parity laws bringing equality to how services are coded.

Back in medical school I developed a passion for psychiatry. Unfortunately, I also had to accept it is grossly misunderstood and sometimes not even seen as a medical specialty. I even had to endure jokes from family about psychiatry. But psychiatry is no less real as a medical specialty than neurology or cardiology. I feel the future of psychiatry holds much greater growth and expanded knowledge than any other medical specialty. So why is it treated as a step-child to medicine? The culture of stigma toward mental health is pervasive. This is both in our general culture as well as medical culture.

It is obvious in our general culture how and why the bias against mental health exists. One extensive study found it is largely lack of education or understanding and exposure. Unfortunately it seems this is a similar problem in the medical culture as well. Some of this bias has been reflected and perpetuated in the old CPT coding. The old coding had psychiatry cordoned off with its own set of codes and documentation as if it did not fit with the rest of medicine. The CPT changes going into effect will serve to better codify psychiatry as medical specialty. Having similar documentation as well as more and more electronic records will allow for improved medical consultation and crosstalk among specialists. I expect this will draw more appreciation for psychiatry.

I believe the CPT changes will help patients create new understanding of psychiatry as a medical specialty. It is weekly that I take time to explain to a patient what training a psychiatrist has versus a psychologist versus a therapist. And I smile and say, “Yes I went to medical school.” Coming in for psychiatric services, they will have even more medical attention much like they would at any other doctor’s office. They will be weighed, height checked, blood pressure. We will track and inquire more regularly about other health care issues. It will be clear this is a doctor’s office they are coming to. All the while, we will not lose sight of person care we so proudly cherish in psychiatry. I believe it is possible to be the medical specialty to care for the person and treat the mind. That is how I was drawn to psychiatry during medical school in the first place.

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