Psychiatry Coding & Reimbursement Alert

Prolonged care codes get better specificity to psychotherapy services.

Like every year, September brings in the annual unveiling of new, revised, and deleted CPT^® codes for the following year. Initial sneak peeks don’t show many updates for psychiatry-related codes, but you’ll still want to be aware of how your reporting might change in 2016.

Check on Descriptor Changes to Prolonged Care Codes

When CPT^® 2016 goes into effect, you will not only have to be aware of some of the new codes that have been added, you will also need to be aware of descriptor changes to some of the existing codes. One such set of codes that you will need to pay attention to as a psychiatry coder are the prolonged care codes.

You will see the following descriptor changes to these codes in CPT^® 2016:

• 99354 (Prolonged serviceevaluation and management or psychotherapy service[s] [beyond the typical service time of the primary procedure] in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour [List separately in addition to code for office or other outpatient Evaluation and Managementor psychotherapy service])
• 99355 (Prolonged serviceevaluation and management or psychotherapy service[s] [beyond the typical service time of the primary procedure] in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes [List separately in addition to code for prolonged service]).

“Parentheticals in CPT^® following the prolonged services codes and code 90837 (Psychotherapy, 60 minutes with patient and/or family member) already specify that prolonged service codes can be used in addition to 90837 for psychotherapy services not performed with an E/M service of 90 minutes or longer face-to-face with the patient,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians. As prolonged care codes are used with E/M and also with psychotherapy services when the service extends beyond typical time, the new descriptors have added language consistent with these parenthetical instructions.

Get to Know 99415 and 99416

CPT^® 2016 will include two new add-on E/M codes to help you capture work your clinical staff performs after your clinician sees the patient for an E/M service. You will be able to report 99415 (Prolonged clinical staff service [the service beyond the typical service time] during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour [List separately in addition to code for outpatient Evaluation and Management service]) and 99416 (…each additional 30 minutes [List separately in addition to code for prolonged services]) to seek additional, deserved reimbursement.

“Now, here is a set of codes to really sink your teeth into; we hope!” says Suzan (Berman) Hauptman, MPM, CPC, CEMC, CEDC, director of PB Central Coding at Allegheny Health Network in Pittsburgh, Pa. “Often times, a physician’s time with the patient only paints a partial picture of what occurred during the visit. It could have been that the staff was asked to give an injection, but the patient was uncooperative. It might include education for a new medication, therapy, or options for care that go far beyond the time illustrated in the E/M code, but that education doesn’t have to be that of the physician. The staff members in a physician’s office are important to the care of the patient and also are an expense to the physician. These codes make good sense all around to be included in the new code sets. This may also come into play with the trend of coverage for more preventive services. I am anxious to see how these codes play out in policy and, if reimbursable, what might that reimbursement look like.”

Note: Added guidelines to prolonged care codes, 99354 and 99355, mention that you should not report either of these prolonged care codes with the new add-on codes for prolonged clinical staff service codes. In other words, these guidelines say that you cannot use either 99354 or 99355 with 99415 or 99416. “The implication is that prolonged services must be coded based on either the time of clinical staff (99415 and 99416) or the time of the physician or other qualified health professional involved (99354 and 99355), not both,” Moore adds.