The biggest change to CPT coding in psychiatry happened in 2013
I got precisely 30 seconds of CPT coding guidance as a resident in psychiatry at Vanderbilt University Medical Center. A senior resident taught me 3 codes — the one for a new patient (90801), the one for a 50 minute follow-up (90807), and the one to use for a 30 minute follow-up visit (90805). That’s it. Reimbursement issues were the last of my concerns — no one goes into medicine to learn how to code office visits properly. I carried this basic coding strategy with me when I opened my Manhattan private practice in 2007.
Then things changed drastically in 2013–all of the CPT codes I used for the last 12 years were abolished. The replacement was a more complicated coding system which strived to be a hybrid of psychiatry and medicine. As psychiatrists, we not only perform psychotherapy but also medical assessments, order and evaluate blood tests, assess health measures, and prescribe medication. The medical codes that psychiatrists can use since 2013 are called E/M codes, for evaluation and management. These are the same codes that internists and other MD’s use for their outpatient coding.
The New Patient Evaluation
Quick primer on new patient coding in psychiatry by Dr. Dinah Miller
Prior to 2013, all new patient evaluations were coded the same — a 90801. Now, however, we have several to choose from:
90792 — Psychiatric Diagnostic Evaluation with Medical Services
99203 — Level 3 New Patient Office Visit, Low Complexity
99204 — Level 4 New Patient Office Visit, Moderate Complexity
99205 — Level 5 New Patient Office Visit, High Complexity
Many psychiatrists stick with simplicity — the 90792 is the direct replacement for 90801 and that’s what they use. That’s what I did initially as well. However, when I learned of the difference in reimbursement for the codes above (even though as an out-of network practitioner it meant my patient received better reimbursement), I quickly optimized my coding for each new patient visit. My intakes are usually 90 minutes long and involve an extensive history along with ordering labs and reviewing past records therefore I could often justify using codes 99204 and 99205. While insurance companies vary how they reimburse different codes, let’s look at the standard Medicare reimbursement, since many payers base their fees on Medicare:
90792 — $153
99204 — $167 (minimum 45” if based on time)
99205 — $210 (minimum 60” if based on time)
One should always review the AMA CPT coding guidelines to justify which code is most appropriate. But keep in mind that E/M codes can be used not only based on medical complexity, they can also be used based on the duration of time spent with the patient, provided at least half of that time is spent on counseling or coordination of care.
One of psychiatry’s biggest contributions to our patients is the face time that we spend with them. The new coding now factors that in for our new patient appointments. We often spend 45, 60 or more minutes with new patients. When this is the case, and greater than 50% of the time is spent on counseling and/or coordination of care, then the E&M codes are warranted and justified. And they reimburse better which will benefit both you and your patients.