CPT Coding Changes for 2013

During the past month or so we have received announcements from the Florida Federal Advocacy Coordinator for the APA and the National Council for Community Behavorial Health Care regarding changes for CPT Coding in 2013.   As we have reviewed this infomation it is noted that the most significant changes are for Psychiatrist and nurse practitioners.  A crosswalk regarding these coding changes is attached below.   It appears that beginning in 2013 those medication providers will be using a two code system.  The first code will be an evaluation and management code followed by an add on code.   For those providers who do not do medication management it is more of a simple change from 90804 to 90832.  For the Interactive codes you are permitted to use an add on code when complexity indicates the need for one but in general the crosswalk shows that the codes 90804, 90806 and 90808 will be deleted and replaced with 90833, 90836, and 90838.  

CPT-Crosswalk

The Medicare rate schedule should be out by the end of November and perhaps at that time we will see some mention of this but at this time none of the Medicare MAC’s have mentioned this change nor have we seen anything coming from the different insurance carriers.  All this information is coming from the various associations and has not been implemented or addressed by insurance companies at this time.  We will have to wait an see how they intend to handle the transition.  More on this as things come up.

October 30, 2012     Update we have just received notification from New Directions who is the Managed Care for BCBS of Florida that these codes will be changing effective 01/01/2013.  We have yet to see anything posted for Medicare at this time.  More as these changes are recognized by the different insurors.

Medicare Fraud

Today in the news there was a flash across the screen concerning  the arrest of providers for Medicare Fraud.  Be aware of what constitutes fraud and what you can do to keep your practice ethical and legal.  Fraud is when services are either not considered necessary because the diagnosis and patient’s condition do not require the type of treatment that you are billing for or services that are billed were not provided.  The Medicare Population may not always have the best memory about the visits, so you need to protect yourself.  One of the ways I would suggest is that you maintain your records accurately and obtain a signature each and every time you see a client.  You can use a sign in sheet with removable labels so as not to compromise confidentiality.   I would also recommend that you make sure  clinical documentation backs up each and every visit.  The documentation should include a note that confirms your diagnosis and prognosis on each and every visit.  If Medicare comes knocking on your door you will be asked to produce this and because you are a Medicare participating provider you must comply.     Some of the things these providers that were arrested are clearly fraudulent and make it really bad for the rest of providers that are merely trying to make a living.  So my advice to you is keep good records.  Make sure that if you are billing for a service it was indeed provided and you have the documentation to support it.