CPT Code Changes for 2013

CPT Code Changes for 2013:  Let's Get Ready Together!

Dear Mark, What is happening? On September 17, 2012, the American Medical Association (AMA) made the 2013 Current Procedural Terminology (CPT®) code set public, providing details about the significant code changes for psychiatric services. Effective January 1, 2013, the CPT codes you have been using for Diagnostic Interview Examination (90801, 90802), Pharmacologic Management (90862), and the majority of psychotherapy services will be eliminated. In place of the old codes, you will: Use new codes for psychiatric "primary procedures" and report "interactive complexity" when present. Use Evaluation and Management (E/M) codes alone or in conjunction with a psychotherapy time code. In the latter scenario, reporting interactive complexity may also come into play.

So  What Does All of This Mean to Credible and to Our Partners?

To Credible, it means taking the necessary actions to support our Partners, as you adopt the CPT code changes - providing best practices and training in the coming weeks, as well as programming inside the November release cycle. To our Partners, it means making adjustments to your Credible Billing Matrix, forms, prebilling checks, and training your staff. With an understanding of the new CPT coding concepts and how to use the new features in Credible, your staff can correctly document and bill services.

A Little Background Information:

Understanding why the CPT codes were changed and what a few of the benefits are may provide motivation as your Agency makes preparations. The AMA designed the new codes and coding methodology to more accurately reflect current psychiatric practice and incorporated input from key organizations such as the American Academy of Child & Adolescent Psychiatry (AACAP) and American Psychiatric Association (APA).    The benefits include: New CPT codes that provide a more detailed description of the services and convey the complexity of the clients. Potential for increased revenue when using E/M codes.  The AACAP provided the following example: Medicare payment for 99213 is 20% more than it is for 90862 and, for 99214, it is 78% more. Ability to bill for "Psychotherapy for Crisis" - a new service in the 2013 CPT code set.

Three Things Our Partners Should Do Now!

Familiarize your Agency with details about the CPT code changes. Resources: Free National Council webinar CPT Code Changes for 2013:  Impact on Behavioral Health; November 9, 2012, 12-2 pm EST  https://www2.gotomeeting.com/register/45154224 AACAP webpage:  Reimbursement for Practitioners (look for the 2012 to 2013 Crosswalk Table, E/M and Psychotherapy Coding Algorithm, and Interactive Complexity Guide) APA webpages:  Changes to Psychiatry CPT Codes  CPT Code Changes for 2013 Help your physicians and billing staff become familiar with E/M coding - the knowledge will help ensure that services are billed correctly and your Agency receives appropriate reimbursement. Resources: Educational materials on AACAP webpage:  Reimbursement for Practitioners AMA's CPT® 2013 Professional Edition Contact your payers to find out if they are aware that the CPT codes are changing and if they will be using them effective January 1, 2013. Although all payers are required to use the new CPT code set by the first of the year, there could be a transition period. The Centers for Medicare & Medicaid Services (CMS) should confirm their transition period decision in November when they release their fee schedule. Other insurance companies will be posting their new fee schedules throughout the end of the year. Look for more communication from Credible in the coming weeks that will help our Partners get your Credible system and your staff ready for the CPT code changes for 2013. If you have any questions please contact your Credible Account Manager or Implementation Manager.  CPT is a registered trademark of the American Medical Association.

Best Regards, Shelby Shelby Brewer Chief Operating Officer (0) 301-652-9500 | (fax) 240-744-3086 | shelby.brewer@credibleinc.com www.credibleinc.com