CPT Coding Changes

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Reimbursement

  • 1.  Reimbursement

    Posted 01-07-2013 05:47 AM
    I had reviewed all the national webinars and charts, sharing in some of the anticipation around being able to bill more flexibly based on the patients needs, using lower codes for brief progress checks and higher codes for more comprehensive work. Though it seems that this will be an irrelevant point as some payers are not differentiating reimbursement for each of the codes (99211-99215). Is anyone else experiencing this? 

    http://www.omh.ny.gov/omhweb/clinic_restructuring/faq.html
    "Does the Evaluation and Management (E&M) code affect the weight of the visit?  For example, will we be reimbursed at a higher rate for a psychiatric assessment with an E&M of 99215 as compared to 99212, with the same diagnosis?  

    For OMH-licensed outpatient clinics, the E&M code does not affect the weight of the visit when billing for Medicaid.  A 99212 will pay the same as a 99215 with the same diagnosis."


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    Steven Korona
    Vestal NY
    (631) 680-7859 (home)
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    APNA Annual Conference Call for Abstracts Deadline 3/2


  • 2.  RE:Reimbursement

    Posted 01-11-2013 02:59 PM
    Steven-

    There's an interesting discussion about "interactive complexity" with E&M and the psychotherapy add-on code at: 
    http://www.carepaths.com/new-cpt-codes-likley-to-increase-psychiatrist-reimbursement-and-make-cost-containment-more-difficult/ 

    -Mike
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    Michael Terry, DNP, APRN-PMH/FNP
    Clinical Associate Professor
    University of San Diego
    San Diego CA
    (415) 637-1810

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    MichaelTerry
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    APNA Annual Conference Call for Abstracts Deadline 3/2


  • 3.  RE:Reimbursement

    Posted 01-17-2013 11:16 AM

    Hi Mike,
    The link is broken.  Is there another way to get to the discussion?
    Krista
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    Krista Blough
    APRN
    Sunlight Psychiatry
    Powell WY
    (307) 764-4130 (home)
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    APNA Annual Conference Call for Abstracts Deadline 3/2


  • 4.  RE:Reimbursement

    Posted 01-17-2013 11:15 AM

    Hello Steven,
    I am not sure how private insurance will handle the new codes for us.  But Wyoming Medicaid has adjusted reimbursement for 99213 (about $70) 99214 (about $100) and 99215 ($140). 

    Medicaid is a state-by-state system, but it seems totally wrong that you get the same reimbursement for a simple med check versus the suicidal patient - I guess I'm blessed to live in Wyoming! The documentation is much more complicated with the new system but it is also more reflective of how the patient is doing.  It also encourages me to be doing the rating scales that I kept promising myself that I would be doing.  Now I take vitals and do rating scales all the time.  It makes me feel like I am getting a more objective picture of the patient.  But it is more work, for sure. 
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    Krista Blough
    APRN
    Sunlight Psychiatry
    Powell WY
    (307) 764-4130 (home)
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    APNA Annual Conference Call for Abstracts Deadline 3/2