E/M Coding Remains Tricky in 2018 for Psychiatry Services

Collaborative Care Model Includes New Codes and Requirements

Extensive changes to CPT coding in recent years have dramatically changed how psychiatrists bill for services, highlighting the importance of understanding E/M codes for both inpatient and outpatient care. Coding for evaluation and management services and psychotherapy has always been tricky, but changes introduced for CPT in 2018 may have you in a fright. Don’t worry! We sort out the new codes for you below as an early Halloween treat to help coders deal with the imminent changes and overcome common pitfalls.

Don’t Let New E/M Codes Make You Nervous

In 2017 Medicare agreed to cover codes 99378 and 99359, while HCPCS codes G0502, G0503, G0504 and G0507 were added, according to CMS FAQs. But further changes go into effect on January 1, 2018, when G0502, G0503 and G0504 will be replaced by new CPT codes 99492, 99493 and 99494 for Psychiatric Collaborative Care Management Services.

In addition, 99483 and 99482 will be introduced. Here’s are the basics of how the five new E/M psychiatric codes break down:

  • 99483: Typically a 50-minute assessment of and care planning for a patient with cognitive impairment
  • 99484: Care management services for behavioral health conditions, involving at least 20 minutes of clinical staff time per calendar month
  • 99492: Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities
  • 99493: Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities
  • 99494: Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities (this must be listed separately in addition to code for primary procedure)

The collaborative care model that CMS has moved to is a model of behavioral health integration that enhances typical primary care by adding two key services: care management support for patients receiving behavioral health treatment and regular psychiatric inter-specialty consultation to the primary care team, particularly regarding patients whose conditions are not improving, according to medical coding expert trainer Letitia Patterson, MPA, RHIA, CCS-P, CPC, CPMA, CPC-I.

Billing All Together Now!

Mental health coders will recognize some of the other CPT coding issues and pitfalls from years past.

For instance, what services can be billed together? Psychotherapy and E/M can be billed together (+90833, +90836 and +90838), but may not be billed with prolonged services. In order to be billed together, the psychotherapy and E/M services provided must be separate and easily recognized as significant. To code properly, the level and type, not time, of E/M service must be determined first.

An important exception to services billed together would be psychotherapy for crisis: Time-based codes +90839 and +90840 may not be billed together with 90791, 90792, 90832-90838, or 90785.

Time Is Ticking

Another pitfall involves when time is a factor in selecting the right code. Per current coding guidelines, time is a factor for psychotherapy (90832, 90834 and 90837), psychotherapy for crisis (90839 and 90840) as well as psychotherapy paired with E/M services (90833, 90836 and 90838). Time also factors into prolonged psychotherapy (90+ minutes), which covers outpatient codes 99354 and 99355, and inpatient codes 99356 and 99357.

However, family psychotherapy (90846, 90847 and 90849), which is considered medically necessary treatment of the family unit when maladaptive behaviors of family members are exacerbating the patient’s illness in the treatment process, is based on who is present during services provided instead of the time spent with the patient. And group psychotherapy (90853), in which personal and group dynamics are discussed, allowing emotional catharsis, instruction, insight and support, is not time-based.

For any doubts about services provided, time spent, location of patient (hospital, hospice, home, etc.) or their status as outpatient or inpatient, coders should immediately clarify with psychiatrists.

Keeping Up with the Changes

Although it may appear daunting to keep up with what’s new, it’s important to remember: ensure the psychiatrist documented medical services performed as thoroughly as possible. For any doubts, refer to the latest CPT guidebook issued by the AMA. And keep track of changes carriers may make to which codes they will accept, and be aware that each carrier may have a different interpretation of how such codes are to be selected, advises the AAPC.

Behavioral health specialists can ensure they understand current and upcoming CPT coding changes and remain compliant by joining medical coding expert Letitia Patterson, who provides a thorough overview of current clarifications and descriptors to CPT codes, as well as the latest HCPCS codes in the collaborative care model for behavioral health, in her talk on E&M Coding for Psychiatry Services for AudioEducator. Ideal for psychiatrists, coders and compliance specialists alike, Letitia’s webinar will guide you through key concerns such as how to be thorough in documentation, who can and can’t use E/M codes, and how to bill for multiple services performed on the same day.

One thought on “E/M Coding Remains Tricky in 2018 for Psychiatry Services”

  1. Debra Bales says:

    where can I find info on documentation guidelines for 90832 psychotherapy for FQHC’s and Psychology practices?

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