New Billing Codes

[KillerDiller]

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Is anyone who is currently doing clinical work running into problems with the new CPT codes that went into effect on 1/1/13? At the clinic where I do my internship, we discovered that the old code for a session of individual therapy, 90806, has changed to two new codes. So, what's the problem? Well, the 90806 code previously covered any individual therapy session that was 45-60 minutes long. Now, there is a code for a session that lasts 45-52 minutes and a different code for a session lasting 53-60 minutes. The main insurance company that we bill (> 50% of our client base) has changed reimbursement rates to reflect the new codes. They are paying the same rate for the 53-60 minute session as they used to for the 90806 code. They pay $10 less for the 45-52 minute code. I'm guessing they are not the only insurance company who will do this. Normally our sessions are 50 minutes (this has been pretty standard at all the sites where I've worked). However, now if clinics and private practice clinicians want to avoid taking a pay cut, they have to extend sessions at least another 3 minutes.

What are everyone's thoughts about this? I'm pretty resistant to it because I already feel that 10 minutes is a time crunch when it comes to writing the note and then preparing for the next session.

 

[Doctor Eliza]

Is anyone who is currently doing clinical work running into problems with the new CPT codes that went into effect on 1/1/13? At the clinic where I do my internship, we discovered that the old code for a session of individual therapy, 90806, has changed to two new codes. So, what's the problem? Well, the 90806 code previously covered any individual therapy session that was 45-60 minutes long. Now, there is a code for a session that lasts 45-52 minutes and a different code for a session lasting 53-60 minutes. The main insurance company that we bill (> 50% of our client base) has changed reimbursement rates to reflect the new codes. They are paying the same rate for the 53-60 minute session as they used to for the 90806 code. They pay $10 less for the 45-52 minute code. I'm guessing they are not the only insurance company who will do this. Normally our sessions are 50 minutes (this has been pretty standard at all the sites where I've worked). However, now if clinics and private practice clinicians want to avoid taking a pay cut, they have to extend sessions at least another 3 minutes.

What are everyone's thoughts about this? I'm pretty resistant to it because I already feel that 10 minutes is a time crunch when it comes to writing the note and then preparing for the next session.

Thankfully, we have a billing department, so I don't have to be up on every little detail. However, I was told by one of our most awesome billing ladies that for some insurance companies billing for a 60 minutes requires special authorization (i.e., they are not going to let you do it.) A typical session is the 45 minute code. Our practice lets us choose whether to do 45 or 50 minute sessions and tells us to bill the 45-52 minute code.

Our state psychological assn has sent out many helpful emails on the changes. If you don't belong to yours, you might consider it. You also might be able to contact them for further guidance.

I think this is yet another way that the insurance companies are lowering our rates. 🙁

Best,
Dr. E

 

[MBellows]

Is anyone who is currently doing clinical work running into problems with the new CPT codes that went into effect on 1/1/13? At the clinic where I do my internship, we discovered that the old code for a session of individual therapy, 90806, has changed to two new codes. So, what's the problem? Well, the 90806 code previously covered any individual therapy session that was 45-60 minutes long. Now, there is a code for a session that lasts 45-52 minutes and a different code for a session lasting 53-60 minutes. The main insurance company that we bill (> 50% of our client base) has changed reimbursement rates to reflect the new codes. They are paying the same rate for the 53-60 minute session as they used to for the 90806 code. They pay $10 less for the 45-52 minute code. I'm guessing they are not the only insurance company who will do this. Normally our sessions are 50 minutes (this has been pretty standard at all the sites where I've worked). However, now if clinics and private practice clinicians want to avoid taking a pay cut, they have to extend sessions at least another 3 minutes.

What are everyone's thoughts about this? I'm pretty resistant to it because I already feel that 10 minutes is a time crunch when it comes to writing the note and then preparing for the next session.

If you are a member of ACA, there was an article summarizing the changes in CPT codes for therapy.

 

[Therapist4Chnge]

KD, there is a great listserv that talks about billing issues called "MHBilling" (a GoogleGroup). I've been on it for a couple of years and I have learned a ton during that time. These changes have made for a plethora of reading, but I highly recommend it for anyone trying to get a handle on billing issues. Thankfully we have a billing service (and I don't do therapy), so I thankfully have avoided much of the drama.

You may want to check out Dr. Tony Puente's powerpoint on CPT Coding & Billing: http://psychologycoding.com/ He is a whiz with this stuff.

 

[KillerDiller]

Thanks for the suggestions, everyone. I'll admit, I'm not very involved in organizations that cater specifically to practicing clinicians (the ones I am a part of seem very focused on their particular topics, and haven't mentioned anything on the issue). I hadn't thought about it before, but I suppose it will be important to join some broader organizations now that I'm almost done with school.

 

[deleted176373]

This kind of non-sense is what makes me happy to be a military provider (yes, we still play the billing code game but what I make is not dependent on the coding.) We are in the process of still switching our electronic records to accept the new codes, until then I guess we are keeping the analysts busy.

I plan to extend my sessions an extra five minutes. I can get the progress notes done during lunch, which I never seem to get a full hour for anyway.

M

 

[Pragma]

Thanks for the suggestions, everyone. I'll admit, I'm not very involved in organizations that cater specifically to practicing clinicians (the ones I am a part of seem very focused on their particular topics, and haven't mentioned anything on the issue). I hadn't thought about it before, but I suppose it will be important to join some broader organizations now that I'm almost done with school.

State associations (where you think you'll be working) can be great for networking, and usually they have conferences as well.

 

[Doctor Eliza]

State associations (where you think you'll be working) can be great for networking, and usually they have conferences as well.

+1 Ours sometimes even has postdoc opportunities mentioned on the listserve.

 

[Doctor Eliza]

I posted about this on another thread, but a recent conversation with our senior billing person confirmed that insurance companies have used the new CPT codes to shave a few dollars off each session's reimbursement. Nice, huh?

If you have a PhD, please consider an academic career!

Dr. E

 

[Therapist4Chnge]

If you have a PhD, please consider another career!

Dr. E

Fixed that for you...😉

 

[AcronymAllergy]

In some ways, we have only ourselves to blame--psychologists contribute relatively paltry amounts of money to our political action committees, which means that we subsequently have relatively paltry amounts of influence on Capitol Hill and in state legislatures nationwide. Sad but true.