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CPT Code Changes for Mental Health Providers

Visit our CPT Code Guide for up to date information on the 2013 CPT Code changes.

There are new CPT Code Changes for 2013

August to November 2012 saw the final approval steps to create sweeping changes to the CPT codes used by mental health providers.  These will all be rolled out January 1, 2013.  What’s more, the codes we are familiar with using will be deleted.  Among some of the codes are the initial evaluation, therapy, therapy with evaluation and management, medication management, and all interactive codes.  So it is critical to know what these new codes are to use them appropriately that services rendered are identified and reimbursed correctly.

The general shift in the codes is to make them more reflective of the E&M codes and follow general CPT guidelines. Among the therapy codes there are now three basic codes labeled at 30, 45 and 60 minutes respectively.  For therapists, these are the basic billed codes.  For med providers performing medical services, the appropriate E&M code is used and the therapy is an add-on code if also performed.  For prescribing psychologists the additional code of 90863 is used along with the above codes when medical services are performed.

Interactive services are now an add-on to most of the therapy services.  There are broader definitions for interactive services which include both adult and child populations.  If conditions are met for interactive service, they are added on to the standard visit service codes being used.

Crisis psychotherapy is another new code which will generally be used by non-medical providers.  Medical providers would be encouraged to use appropriate E&M codes in these circumstances.  Crisis psychotherapy involves dealing with an immediate crisis and is defined by total face-to face time with the patient and/or family over the course of a day.  For time over 60 minutes there is an additional code to identify extended services.

Time definitions in the CPT codes for mental health services have changed.  Other than inpatient service, it is all defined as face-to-face time.  Time is now based on a range like other CPT codes.  Whatever code best fits the time is the one used.  This is considered the half-way point to the code or between two similar codes.  An example is the 45 minute code would be used for time ranging from 38 minutes to 52 minutes.  Time with the E&M codes cannot overlap so each must stand alone on their own merits.

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Your own professional organization should also have more detailed information on the code changes.  At the American Psychiatric Association, that would be www.psychiatry.org/practice.  At that site, all of these codes are well defined and there is a 2-hour CME E&M primer available to members.  I would also recommend purchasing the American Medical Association’s 2013 CPT codebook.  It would be a good investment as backup to address any ongoing questions.

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