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Procedure Code (CPT) Changes for Mental Health Services After the recent completion of the human genome researchers found that injection of DNA with a non diabetic’s  genetic code into a diabetic causes the diabetic’s   liver to secrete a hormone that fools the pancreas into thinking blood sugar is high promoting the  production of insulin. Similar genetic treatments for chronic illnesses and many more in progress have  required a January 1st 2013 revision  of the original 1983  Current Procedural Terminology (CPT). The new codes are available at the AMA online book store or by ordering them by phone from the AMA. (1) The 2013 codes have not yet  completely replaced the codes preceding them and are not yet (as of September 2013) required  by all health care plans or third party insurers, Numerous and complicated, they  require major changes in computer billing programs,  tending  to  overwhelm health care providers. They foster a cottage industry of medical coders many of whom work from home. The increase in code complexity also results from competition between specialties for part of the limited funds that Medicaid and Medicare make available to providers each year. Each specialty organization revises its codes to maximize its members’  share of the pie. It’s the mission of the AMA's Relative Value Update committee (RUC) is to determine how the money available to pay health providers for Medicaid and Medicare recipients is to be divided,   The RUC considers the relative time and effort required for each service as well as  the office expenses of the provider in assigning relative value units to each procedure. Health care plans tend to set their reimbursement relative to the RUC's findings. In revising mental health procedures performed by psychiatrists, psychologists, social workers and specialty providers such as addiction counselors, the RUC used a random survey of 1400 psychologists and 100 psychologists attending a state leadership conference. The codes standardize procedures and make reimbursements to providers more equitable. They improve communication between physicians and between physicians and hospitals which minimizes duplication of services. “Add ons” to individual codes now allow multiple services to be billed in single sessions. A mental health example is (2) : Psychiatric Diagnostic Evaluation  (90791)- which  may or my not precede  treatment. Pharmacologic management (90863) –which may stand alone or be part of a psychotherapy session The new codes recognize  changing  psychotherapy practices, objectifying the interaction between significant others by giving clients  an opportunity to improve communication and behavioral patterns under the supervision of a therapist. For example:

Individual psychotherapy session including a significant other (90832-4-7) Couples or marital therapy (90837), Crisis intervention (90839—including “add ons” of 30 minutes each (90840 ) .  In former years these  therapies were excluded from health plans because insurance companies could not get the actuarial data  needed to set premium rates. For example,  how can one determine the incidence of marital discord which lacks the specific symptom patterns of  Depressive Reaction or  of Obsessive Compulsive Disorder?

References: 1.Current Procedural Terminology (CPT) available for purchase at the American Medical Association (800) 621-8335 or online at http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt.page. 2. 2013 Psychotherapy Codes, www.apapracticecentral.org/codes