Tuesday, November 27, 2012

Can Psychoanalysis be Coded with the New CPT, E/M Codes?

The blogger -Psych Practice- who posted on how to figure out an E/M code which I stole below, did  a wonderful  job of giving a clear set of directions on how to do this, though I have to say that I got nauseous half-way through because it is so long and complex with so many charts, but it does explain it.

  S/he wrote a follow-up blog post on how to code for a psychoanalytic session with Socrates as an example (I was a little confused about the Speech: Greek, Appearance: Toga, but I then I got it).  Anyway, it's very clever, and it makes the process seem a little less intimidating, and it does a wonderful job of incorporating the E/M portion of the session into what naturally flows without requiring the therapist to collect irrelevant data for the sake of documentation.  I hope it's right. So here's the link to the how to code E/M + add on therapy for the psychoanalysis of Socrates: http://psychpracticemd.blogspot.com/2012/11/em-psychoanalysis-note-monday.html

What this writer doesn't seem to take into account is the proclamation by AMA that the time spent on E/M must be completely distinct from the time spent on psychotherapy. Any one who has ever conducted or had psychotherapy knows, this is not possible.  It's like the AMA decided the sky is now purple with orange polka dots.  People come in and talk about what's important to them, and if they are depressed and have questions about that Abilify stuff they saw on TV, or are undergoing cancer treatments, or are about to have their knees replaced, that's what they talk about and it's not possible to define one part of a session as "psychotherapy" and instruct them to limit concerns about illnesses & treatments to a specific, time-distinct, portion of the session that is not "psychotherapy."  I believe that we have to say that regardless of what Insurers, the AMA, or the APA believe, that it's simply not possible to disentangle the time devoted to the two.  The stickiness of the issue is whether insurers/medicare are going to claim that if you have a 53 minute session and document a 99213 E/M code with a 90838 (60 minute psychotherapy add on) that you can't have done that much work seeing patients every hour and are going to insist that the therapy code be for the 45 (38-52 actually) minute shorter, session.  For medicare, there is a $45 dollar pay increase if the psychotherapy session goes from 52 minutes to 53 minutes. I'm not the only one who thinks this is all nuts, right?   

I am going to attempt to Live Tweet the 12/4 MPS CPT seminar with the hashtag #cpt.  There's no WiFi at the Sheppard Pratt conference center, so I will be doing it from my phone's touchscreen, typos and all, to the extent that my stamina holds out.  I practiced yesterday by tweeting Vani Rao's Grand Rounds at Hopkins on Traumatic Brain Injury (no, I didn't tweet the patient presentation). I know, I'm repeating myself, but I copied this from a email I put up on the psychiatric society's listserv.