Revised Handbook Guides Psychiatrists Through CPT Coding Thicket

The fourth edition of a handbook for psychiatrists on how to use CPT codes has been published by American Psychiatric Publishing Inc. (APPI).

Procedure Coding: Handbook for Psychiatrists, Fourth Edition, was written by psychiatrist Chester Schmidt Jr., M.D., a consultant to the APA Committee on RBRVS, Codes, and Reimbursement, and two staff members of APA's Office of Healthcare Systems and Financing—Rebecca Yowell and Ellen Jaffe. (Previous editions of the book were titled CPT Handbook for Psychiatrists.)

Schmidt told Psychiatric News that the new edition updates material from the previous editions and adds several new features, including more detailed information, along with case examples, of how psychiatrists can use the evaluation and management (E&M) codes. The book provides templates that show how to document the level of services provided during an initial psychiatric evaluation and to determine the appropriate E&M code to use. (E&M coding is based on level-of-service criteria established by the AMA and the federal Centers for Medicare and Medicaid Services.)

A new chapter provides clinical vignettes for different kinds of service sites, with suggestions for how the vignettes can be coded. It also includes a section on frequently asked questions, derived from queries received by APA's Managed Care Help Line.

"These are not complicated concepts, but they are detailed," Schmidt said. "We have tried to present a lot of detailed information in a user-friendly way. That's been a trend in all of the editions of the handbook—to continually go back and work on clarifying the language."

"The handbook is a great resource for APA members, particularly younger members who are just starting practice," said Carol Bernstein, M.D., immediate past president of APA and a psychiatric educator. "Correct coding reflects the work you do caring for your patients and ensures that you are reimbursed appropriately. Some physicians tend to down code out of fear, depriving themselves of proper reimbursement."

The genesis of the handbook was in the late 1980s and early 1990s, when the AMA substantially revised the CPT manual and the federal government adopted the Resource-Based Relative Value Scale for paying physicians in the Medicare program.

"Those two events really required significant education for all physicians about how to deal with the new codes and to come to grips with the new model for reimbursement," Schmidt said. "APA recognized that there was a real need for something to educate the practicing psychiatrist on how to best use these codes, and to learn how payers manage the codes and process them in a way that eventually leads to reimbursement," he said.

Schmidt said real fraudulence, though not unheard of, is rare. More often clinicians, lacking information, use poor or inadequate documentation that leads to trouble.

"There is a lot of deficiency in the way psychiatrists document their services, especially among solo private practice psychiatrists," he said. "Notes can be really sketchy and sometimes clinicians have difficulty defending their charges when audited. So far as the federal government is concerned, if it wasn't written down, it didn't happen."

But Schmidt said psychiatrists who read and assimilate the handbook's advice will be safe. "If you read this and use the information in it, you are going to be compliant with the documentation requirements of CMS and other payers," he said.