Friday, April 15, 2011

PT: Psychotherapy "Alive and Talking"

This month's Psychiatric Times continues the discussion [registration required :-( ] about the NY Times article on psychotherapy that Dinah and readers discussed on April 9. This time, our colleague, Ron Pies MD, authored this article which deconstructs the myths perpetrated in the NYT article, which interviewed a med check doctor who found it "sad" that his patients found him to be important to them in their lives (read the article for the full flavor).

I'm glad that Ron pointed out (as we have) that the 2008 Mojtabai and Olfson article -- which implied that only 11% of US outpatient psychiatrists provide psychotherapy -- was a misleading statistic. Why? Because they did not consider brief psychotherapy sessions (30 minutes or less) to be classified as "psychotherapy" for their session. Thus, a 90807 (45-50 min) is considered psychotherapy, but a 90805 (20-30 min) would not be considered so, even though the AMA's CPT manual defines it as psychotherapy. Also, brief and supportive forms of psychotherapy are often given even when only a "med check" is billed. Nonetheless, the sound bite from that article has been: "Only 11% of psychiatrists do psychotherapy". It just ain't true. As Mark Twain said, "There are three kinds of lies: lies, damned lies and statistics."


moviedoc said...

Yes, Roy, but how much of those 45-50 minute "psychotherapy" sessions was actually devoted to psychotherapy as opposed to an extended "med check" along with discussion of completing forms and other administrative issues. Even when you go to a non-physician psychotherapist these days you may spend much of the time talking about meds, or the latest thing in alternative treatments.

Anonymous said...

My thoughts: If I'm seen for a 15-20 med check appointment, and the psychiatrist spends 3 minutes asking me, "What's going on in your life? Now remember, we don't have much time left. Just tell me briefly," is that really psychotherapy? The doctor can use the code for psychopharm visit with brief psychotherapy all he wants, but billing an insurance company doesn't change the REALITY of the visit.

moviedoc said...

"is that really psychotherapy?"

Anon, that is a great great question!