Thursday, November 29, 2012

Ranting on KevinMD about CPT Code Changes

I need a new obsession.  It may be a few weeks, I still don't know how this new coding works, or what I'm going to tell my patients, or how I'm going to change my invoice system to deal with all the new codes.  Over on KevinMD, I outlined all of my angst, plus my frustration with how the new coding deals with Medicare.  Please do check out my Rant of the Day.


jesse said...

It is all so confusing and I share your angst. Those of us outpatient psychiatrists who read these blogs and are active in the APA at least know of this even if we do not understand it. What about all of those APA members who don't have a clue about it? I wonder if there will be overlap in that the old codes will be allowed and honored for a number of months.

Joel Hassman, MD said...

This is very bad news for psychiatry in general, because it will not lead to simplification and better patient care, it will just drive patients and providers away from services, at least with taking insurances, and not just Medicare mind you. And auditing will grow exponentially, because let's be honest Dinah, how many of our colleagues will fudge the documentation to try to legitimize the highest reimbursement rates while not providing the actual care the rates are intended? I am actually debating whether it is time to leave private practice with insurers for good. And the outcome overall will be PCPs and other non psychiatrists will become defacto psychopharmacologists.

Much to the dismay and detriment to patients overall. Yeah, antipsychiatrists are clapping today, but once the carnage plays out, we'll see who gets blamed next! And the APA supported this? Between this and the DSM5, who needs competition and antipsychiatry advocates, when our own redefine sabotage!!!

Anonymous said...

Dr. Hassman,

I wish you would stop stereotyping people who have legitimate claims against psychiatry. Did you not read Rob Lindeman's posts from a previous blog entry about how he had a patient who was being coerced by a psychiatrist to take meds and how powerless he felt?

By the way, I do agree with you that the problem with the overprescription of psych meds extends beyond psychiatry. In my opinion, I was bullied by a former regular doctor to take psych meds when I felt that simply would have been a bandaid and not address the underlying problem.

Speaking of transcending psychiatry, the problems that Dina speaks about regarding coding a visit correctly are problematic in the entire field of medicine. Pretty soon, patients will do better practicing self medicine vs. seeing a physician that will amount to about a 5 minute visit after all the other minutia is taking care of. Actually, I think it is happening now.

Of course, we can't have an evil singled payer socialized medicine program that would solve these issues and allow doctors to gasp practice real medicine. Gotta keep all the insurance agencies in business so doctors can have the fun of submitting their claims a million times before getting paid.


jesse said...

Boy, I'm with Joel Hassman here. The codes will be used to maximize reimbursement and institutions will push doctors to use the most reimbursable ways of spending time. As Irv Cohen said decades ago "Philosophy follows Funding."

Joel Hassman, MD said...

Not clear how my comment is stereotyping people. There are people who have legitimate gripes about psychiatric care, and then there are people who want psychiatry to be exterminated. Let's have a moment of candor and brutal honesty, having been a reader of blogs for over 2 years, there are those who write very hostile things and overgeneralize that anyone who practices psychiatry has no place in the care system. Those latter people are the antipsychiatry folks I mention.

And if you participate in the blogs that are raising debate, there are not people who voice glee any time psychiatry is at risk to be eliminated as a profession? Sorry, that is my interpretation. But, thank you for agreeing about the overprescribing beyond psychiatry. PCPs are really ruining mental health care, they just either don't know it or don't care to see it.

And to jesse, wait for how MANY psychiatrists will overbill, and when insurers catch up with this, and it will be rather quick to be caught, again overgeneralization will make us all guilty until proven innocent. Frankly, CPT coding will end private practice for much of the field within 2 years. To me, part of the agenda of PPACA.

jesse said...

Joel, again I'm with you. To expand further on what Irv meant by "philosophy follows funding," using the maximally reimbursable codes (and here I do mean honestly using them, which of course does not have to, and likely will not, happen) will change the way psychiatry is practiced, to the point where a psychiatrist could be 1) fired from his job, or 2) be considered unethical or practicing substandard medicine if he does not spend his time with the patient doing all of the things which maximize reimbursement.

Irv meant that the way we actually think and consider proper is shaped by funding. This may seem self-evident now, but he said it first, in an APA conference in the sixties.