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CPT Coding Changes

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CPT Coding Changes sorted by thread
 
  NEW CPT codes and documentationJan 19, 2013 1:41 PMCharlene Milkey
  RE:NEW CPT codes and documentation
Jan 20, 2013 9:53 AMCheryl Waskiewicz
  RE:NEW CPT codes and documentationJan 21, 2013 8:43 AMMary Moller
  RE:NEW CPT codes and documentationJan 22, 2013 10:22 PMLynn McClellan
  RE:NEW CPT codes and documentationJan 24, 2013 3:03 AMBarbara Limandri
  RE:NEW CPT codes and documentationJan 27, 2013 11:15 PMRomnee Auerbach
  RE:NEW CPT codes and documentationJan 28, 2013 1:38 PMBarbara Limandri
  RE:NEW CPT codes and documentationMay 16, 2013 2:08 PMRomnee Auerbach
  RE:NEW CPT codes and documentationApr 09, 2013 2:33 PMKathleen Kelley
  RE:NEW CPT codes and documentationApr 10, 2013 9:23 AMMary Moller
  RE:NEW CPT codes and documentationApr 10, 2013 9:25 PMKathleen Sheridan
 

1.
NEW CPT codes and documentation
From: Charlene Milkey
To: CPT Coding Changes
Posted: Jan 19, 2013 1:41 PM
Subject: NEW CPT codes and documentation
Message:

Has anyone found a documentation form that is sufficient to meet the new CPT requirements?  Thanks Charlene Milkey
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Charlene Milkey
family psychiatric nurse practitioner
Stamford CT
(203) 305-5165 (home)
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Charlene W. Milkey
PMHNP-BC
Stamford, Ct
203-305-5165
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2.
RE:NEW CPT codes and documentation
From: Cheryl Waskiewicz
To: CPT Coding Changes
Posted: Jan 20, 2013 9:53 AM
Subject: RE:NEW CPT codes and documentation
Attachment(s):
Message:
 Yes, in the attachments, find 2 notes I am test-driving. 

The first--for E/M based on time and >50% providing counseling and/or coordination of care-- is authored by Seth P. Stein, copyrighted 2007; when I googled his name I learned he is an attorney for the New York Psychiatric Assoc.

The second--for E/M + Psychotherapy--is one I composed based on my listening to the webinars offered by APNA, AACAP, and the Natl Council, to whom I am very grateful for all efforts to assist us.  I wanted a one-page note that incorporates all requirements, with prompts imbedded to guide my thinking and arrive at the right CPT coding.  I welcome comments/critique.

With these 2 notes and the algorithms provided by AACAP, I am feeling like I'm beginning to master this learning curve. 

My best to all,
Cheryl Waskiewicz, APRN
                                                             
  

ROS__

                                                                                                                                                                                           

                                                                                                                                                                                                           


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Cheryl Waskiewicz
Orange CT
(203) 988-7895 (home)
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3.
RE:NEW CPT codes and documentation
From: Mary Moller
To: CPT Coding Changes
Posted: Jan 21, 2013 8:43 AM
Subject: RE:NEW CPT codes and documentation
Message:
Nicely done. Thank you for sharing!

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Mary Moller
Associate Professor, Specialty Director-Psychiatric Nursing
Yale University School of Nursing
New Haven CT
(203) 389-4277 (home)
(203) 737-1791
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4.
RE:NEW CPT codes and documentation
From: Lynn McClellan
To: CPT Coding Changes
Posted: Jan 22, 2013 10:22 PM
Subject: RE:NEW CPT codes and documentation
Message:
Yes this has been a challenge but actually a very interesting one as I love people but also love "numbers"  I have been working with the following documentation...maybe a bit more lengthy than most would like but it breaks it down for me at the beginning and I will refine as my knowledge base increases.

So  Sorry not used to this format yet.  If anyone is interested please email me and I would be more than happy to share what I am doing at this time.  Of course it is a constant work in progress.   Regards Lynn

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Lynn McClellan
Business Owner
Lynn McClellan Behavioral Health Services
Champaign IL
(217) 273-3226 (home)
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5.
RE:NEW CPT codes and documentation
From: Barbara Limandri
To: CPT Coding Changes
Posted: Jan 24, 2013 3:03 AM
Subject: RE:NEW CPT codes and documentation
Message:
Thanks, Lynn for the documentation template. A special thanks to Mary Moller and APNA for posted the CPT coding PowerPoints. This change requires some adjustment and getting folks on board. I have to admit I'm still confused by the E/M necessity of points and I'm trying to incorporate into our documentation.

Our clinic PMHNPs are using Practice Fusion for our EHR. I'm using Lynn's template to create a template in Practice Fusion so our charting can be easier. I like Practice Fusion a lot, especially the ability to create templates. Wish I could hare with others but once its embedded in the program I haven't figured out how to share with others either within or outside Practice Fusion. Of course the other PMHNPs in our clinic can use templates that I develop because I can share with them within the program. Anyone else adapting their outpatient EHRs to aid charting that meets CPT code requirements?
Barbara

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Barbara J Limandri, DNSc, APRN, BC
Professor & APRN
Linfield College School of Nursing
and Portland Dialectical Behavior Therapy Program
Portland Oregon 97210
503-413-8359
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6.
RE:NEW CPT codes and documentation
From: Romnee Auerbach
To: CPT Coding Changes
Posted: Jan 27, 2013 11:15 PM
Subject: RE:NEW CPT codes and documentation
Message:
Barbara,
Isn't there a way to share templates with the practice fusion community? I'm not quite sure how but I know there are templates people have shared that people can use. I also know that in the community/forum area there is a doc who posted how to adapt a word document into a template. Pretty snazzy- I would have to find it again. I like the program- just a couple minor things about it bug me (and I mean minor)- so it's good to hear your clinic is having positive experiences with the program.
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Romnee Auerbach ANP, PMHNP-BC
New Perspectives Center
Salem, OR 503-316-6770 (work)
OR-APNA Board Member
Portland, OR
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7.
RE:NEW CPT codes and documentation
From: Barbara Limandri
To: CPT Coding Changes
Posted: Jan 28, 2013 1:38 PM
Subject: RE:NEW CPT codes and documentation
Message:
Hi Romnee,
You're right that there is a way to share templates, I just haven't taken the time to learn that feature. (Hummm, wonder why?) I sure would like to see the comment about adapting Word docs to templates. The PMHNPs have been using Practice Fusion for about a year now, although the rest of the clinic does not. The management team is beginning to consider it (move like molasses) and one of our managers is also a computer programmer. He said he will help me with the fine tuning elements. Again the key variable is finding time.

This might be a good workshop for Or chapter.
Barbara

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Barbara J Limandri, PhD, APRN, BC
Professor & APRN
Linfield College School of Nursing
and Portland Dialectical Behavior Therapy Program
Portland Oregon 97210
503-413-8359
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8.
RE:NEW CPT codes and documentation
From: Romnee Auerbach
To: CPT Coding Changes
Posted: May 16, 2013 2:08 PM
Subject: RE:NEW CPT codes and documentation
Message:
Barbara,

I love your idea about a workshop for Oregon Chapter... might also bode well with another topic.... gasp.. shall I say ... DSM V?

Know of anyone who speaks or has a wonderful knowledge base in this area about CPT coding?

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Romnee Auerbach ANP, PMHNP-BC
New Perspectives Center
Salem, OR 503-316-6770 (work)

OR-APNA Board Member
Portland, OR

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9.
RE:NEW CPT codes and documentation
From: Kathleen Kelley
To: CPT Coding Changes
Posted: Apr 09, 2013 2:33 PM
Subject: RE:NEW CPT codes and documentation
Message:
After much deliberation, I decided the E&M codes with more than 50% counseling/care coordination were the best fit for most of my visits. I have been using 99214 for my 25minute visits, and 99215 for 40-50 minute visits, which make up the bulk of my practice, without any problems in reimbursement. But in the past week I have had several requests for visits records from clients who have Providence Health Insurance, with Mental Health managed by UBH. I am not contracted with providence or UBH, but my clients cannot afford to pay their bill without insurance, so I am in the unenviable position of having to send my client's confidential records to an insurance company (they consent to this on the billing consent form, but I have never been asked for them before), stick them with a bill they can't afford, or eat the loss and find them other care.

I researched this issue on line, and apparently the 99214 and 99215 codes are triggering audits in many parts of the country. There is no way to for the insurance company to discern from the billing whether the code is based on counseling and coordination of care or complexity, or even whether it is a primary care vs. mental health visit. So, while I await a response to the notes I have sent for clients who request this, I am rethinking whether this is the best way to use the new codes. Previously I was using mostly 90805, 90807, and 90809, and never had any difficulty.

These are all patients with serious mental health issues, with whom I have a longstanding relationship. I feel like I am between a rock and a hard place.

Has anyone else had this experience? Any suggestions or words to the wise about dealing with the records requests?

Thanks,

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Kathleen Kelley, PMHNP
Lake Oswego OR
503-830-3215
kkelleyfaegre@earthlink.net
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10.
RE:NEW CPT codes and documentation
From: Mary Moller
To: CPT Coding Changes
Posted: Apr 10, 2013 9:23 AM
Subject: RE:NEW CPT codes and documentation
Message:
Dear Kathleen,
This is how I billed E&M's 20 years ago in WA State.  The key is 'more than 50%'. I would always include CC, HPI, PFSH (because that is always in the S portion of a S anyway).  Then I would include ROS and the Psych MSE in the O as well as what I did for counseling and/or coordination of care as well as reporting on labs and info from other providers that had come in..  A and P are standard. I had a medicare audit and was taken off the list for further audits because the charting was so complete!

Stand by your timed codes, they are TOTALLY legitimate!

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Mary Moller
Associate Professor, Specialty Director-Psychiatric Nursing
Yale University School of Nursing
New Haven CT
(203) 389-4277
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11.
RE:NEW CPT codes and documentation
From: Kathleen Sheridan
To: CPT Coding Changes
Posted: Apr 10, 2013 9:25 PM
Subject: RE:NEW CPT codes and documentation
Message:
Hi, Kathy.  In my private practice, my ongoing sessions are all 55 minutes and, since I do therapy in addition to E/M services, I code 99213,4,or 5 based on the complexity, etc. criteria and then add my psychotherapy component based on time, such as 90833, etc.  Most sessions result in a 99213 plus 90833 coding.  In researching my decision whether to go with the timed codes I reviewed the CPT manual's definition of "counseling and coordination of care" and found it lacking as a description of my usual sessions.  However, I have used the 99 codes based on time for a couple of patients where medication issues are at the forefront and the situations are relatively acute, so "counseling and coordination of care" is appropos. I would definitely recommend taking a look at that definition and see if it truly applies.  Reimbursement for 99215 has been about the same as formerly paid for 90807.  

The response to billing using E/M plus psychotherapy codes has remained about the same as before the code change.  99213 pays about 60% of the total reimbursement; the psychotherapy about 40%.  And that is the approximate breakdown of my charge for a 99213/90833 session. I am much more comfortable with the idea that my documentation always meets at least the 99213 complexity criteria and often higher (215, 216).  Either way, I feel confident of the documentation, should I have to submit it to support my choice of code.  I'm using the Valant templates and find them very adequate to the task.  As for confidentiality should I be required to share them, the templates are generically "medical" enough that anyone reading them would find little of interest regarding the content of our discussions.  In other words, they're incredibly boring to read but quick and to the point when writing them.  

Hope this helps a little.  Feel free to follow up by phone or email.  We should have lunch! 

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Kathleen Sheridan, PMHNP
Portland OR
(503) 360-6303
www.kathleensheridan.com

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