Major Changes to CPT Codes for Psychiatry in 2013

Effective January 1, 2013, major changes to Current Procedural Terminology (CPT)—the AMA codes used for billing and documentation for all insurers will take place. Five areas of the psychiatric codes section are being modified or eliminated.

  • Changes to the current diagnostic evaluation code (90801) is split into two codes which differentiates if a medical workup was part of the evaluation or not.
  • Psychotherapy codes are now keyed to three levels of time spent with the patient (30 minutes, 45 minutes, and 60 minutes), and inclusion of “add-on” codes when psychotherapy is provided in conjunction with evaluation and management (E/M) work (for example, medication management).
  • The pharmacologic management code (90862) has been eliminated and replaced with existing E/M codes (99XXX series codes) . This change should benefit psychiatrists by permitting them to use an E/M code that reflects the medical and psychiatric complexity of the patient and by allowing use of the psychotherapy add-on codes in conjunction with an E/M code.
  • There is a new add-on code for “interactive complexity” which replaces the current separate codes for interactive evaluation psychotherapy. This can include situations in which there is a need to manage maladaptive communication among participants in therapy, for example, when caregivers’ emotions or behaviors interfere with implementing the treatment plan, or when there is evidence of a sentinel event that mandates a report to third parties. This add-on code can be used in conjunction with an initial evaluation, psychotherapy, and group psychotherapy.
  • There is a new psychotherapy code for a patient “in crisis.”  This code can be used when a practitioner performs an urgent assessment and history of a crisis state, a mental status exam, and a disposition.This may include mobilization of resources to defuse the crisis and restore safety and implementation of psychotherapeutic interventions to minimize the potential for psychological trauma. When a crisis encounter goes beyond 60 minutes, an add-on code for each additional 30 minutes can be used. Psychiatrists have the option of billing an E/M code to describe this work as well.

Additional information about the CPT code changes can be found on APA’s Web site at www.psychiatry.org/cptcodingchanges.