Psychiatrists are girding themselves for major changes in how they bill for their services starting Jan. 1, due to changes in the Current Procedural Terminology codes that were finalized in the 2013 Medicare Physician Fee Schedule.
The bottom line: Some psychiatrists, especially those who primarily do outpatient work, may have a steep learning curve with little additional payoff initially, according to Dr. Ronald Burd, chairman of the American Psychiatric Association committee on codes, RBRVS (Resource-Based Relative Value Scale), and reimbursement.
Dr. Ronald Burd
All psychiatrists will see increased pressure to start using evaluation and management (E&M) codes, which requires knowing the system and more documentation from the physician.
"If you’re used to using the E&M codes for inpatient work, it should translate pretty easily for outpatient work," said Dr. Jeremy S. Musher, who serves on the APA committee on codes, RBRVS, and reimbursement, and is the APA adviser to the American Medical Association (AMA) Relative Value Update Committee (RUC).
"But for psychiatrists who have not used E&M codes, there will be some learning involved in how to use, how to document, and how to bill," he said in an interview.
Reimbursement should eventually rise, but for the first year, the codes have been assigned interim values that aren’t much higher than current pay. Values may rise in 2014, after the professional societies have had a chance to survey psychiatrists on the new codes and the RUC looks at revaluing those codes, said Dr. Musher, medical director for psychiatric emergency services at the Western Psychiatric Institute and Clinic at the University of Pittsburgh Medical Center and president and CEO of the consulting company the Musher Group.
The goal of the coding changes is for all psychiatrists to have "the opportunity to be appropriately reimbursed for the intensity of the work they do," Dr. Burd, who is also inpatient medical director for Sanford Health Services in Fargo, N.D., said in an interview.
Dr. Jeremy S. Musher
The coding revision has been in process for several years, according to Dr. Musher. All codes are reviewed and revised periodically. When some of the psychiatric codes came up for review, the APA and other mental health societies suggested that the codes be revised to pay psychiatrists more appropriately.
Since the last major revision of the codes in 1998, psychiatrists have been locked into an outpatient medication management code (90862) that pays a flat rate, he explained. But patients have become more complex, presenting with an increasing number of comorbidities. Patients are also more complicated from a psychiatric standpoint because many have been shifted from the inpatient to the outpatient environment, he said. "The payment structure we are operating under does not account for that," Dr. Musher said.
The new codes more accurately reflect what psychiatrists do, he said. Under the new system, the 90862 pharmacologic management code has been deleted. There is a 90863 code now, which was created for psychologists in states where they have prescriptive privileges. But these codes should not be used by psychiatrists or midlevel providers, according to Dr. Burd.