Billing for Psychotherapy Drops After 2013 Changes to CPT Psychiatry Codes

The proportion of psychiatric visits billed as psychotherapy declined significantly in the period following the 2013 update of Current Procedural Terminology (CPT) codes used for psychiatry, according to an analysis appearing in Psychiatric Services in Advance. Moreover, the most frequently billed psychiatric codes were those for evaluation and management (E/M).

“Given that the majority of visits to psychiatrists included E/M services only, efforts and incentives could be used to increase care coordination, treatment in teams, and colocation of mental health services to support the provision of mental health care,” wrote Tami L. Mark, Ph.D., of RTI International, William J. Olesiuk, Ph.D., of Truven Analytics, and colleagues at the Substance Abuse and Mental Health Services Administration.

On January 1, 2013, the Centers for Medicare and Medicaid Services (CMS) implemented significant revisions to the CPT code set for psychiatry and psychotherapy services, eliminating more than 30 of the most commonly used psychiatry CPT codes and introducing several new codes. The 2013 CPT revisions, formulated by the American Medical Association CPT Editorial Board, were designed to improve the ability of the codes to account for varying levels of work involved in psychotherapy and medical management, among other factors.

For the analysis, Mark, Olesiuk, and colleagues used 2012–2014 data from the Truven Health Analytics MarketScan Commercial Claims and Encounters (MarketScan) database. The MarketScan database reflects the entire claims experience of approximately 30 million individuals with private insurance annually. The sample in this study was restricted to office visits to psychiatrists in 2012 (prior to the CPT code changes) and in 2013 and 2014 (the two years after the CPT code changes).

After controlling for factors related to the patient, practice, and health plan, the authors found that the percentage of visits billed as psychotherapy dropped from 51% in 2012 to 41% in 2013, and 42% in 2014. In 2013, the most common CPT code was the E/M code 99213 (established patient office visit, low to moderate severity), followed by the E/M code 99214 (established patient office visit, moderate severity), and the 90833 add-on code (individual psychotherapy, 16–37 minutes).

“The change in CPT psychiatric billing codes resulted in a significant decline in documented psychotherapy by psychiatrists among privately insured patients,” the researchers stated. “Whether this was due to a change in actual treatments provided or a clarification of the extent to which psychotherapy was actually being provided … is an issue that requires further investigation.”

For questions and answers about CPT coding, see the Psychiatric News article “CPT Coding Q&As From Helpline.”

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