The AMA’s 2013 CPT procedural code book just arrived in the Vālant offices, after a summer’s worth of anticipation around the hints and murmurs of the coding changes on the way for behavioral healthcare providers. You have probably been thinking “What 2013 CPT code changes apply to my psychiatric practice?” It’s not uncommon for hundreds of coding deletions and new additions to appear from year to year in the official CPT guide; however, when your historic pool of coding options has been represented by a few dozen codes, any changes to the coding guidelines for your specialty of care are a big deal and require your careful review and consideration. For mental health practitioners, 2013 is the year.
An additional possibility for the usage of evaluation and management codes in psychiatry is the consideration of coordination of care and/or medical counseling (not psychotherapy). Psychiatrists who are providing medically complex patient care for clients may find that a significant amount of face-to-face time is spent in providing coordination of care on behalf of the client. If more than 50 percent of your face-to-face time with your client and/or your client’s family is used in coordination of care or medical counseling, you may bill your services using an E&M code based upon the total length of time of the appointment. The face time element is used in outpatient or office settings, while inpatient care includes this consideration in addition to time spent at the patient’s bedside or in the patient’s hospital unit. The Medicare Learning Network (MLN) has a E&M publication for providers called the Evaluation and Management Services Guide, which you can view here.
Page 22 provides further explanation of the coordination of care consideration. The publication also contains the 1995 and 1997 Documentation Guidelines for Evaluation and Management Services, two of three main parts of your E&M resource base.