For psychiatrists working in busy outpatient practices, the start of the year can be stressful. Many patients reset their insurance deductibles or switch insurance plans, which affects the cost of each visit. The American Medical Association (AMA) updates the CPT® psychiatric billing codes 2023, and Medicare changes the guidelines for using specific codes.
Changes to Psychiatry CPT Codes 2023
These changes are inevitable, like death and taxes. However, the good news for 2023 is that most outpatient psychiatrists will only experience a minimal amount of these changes.
Time-Based Billing vs. Medical Decision Making
The guidelines for using medical decision-making (MDM) to select the appropriate E/M code for outpatient appointments were modified in 2021. Previously, specific paperwork was required to use MDM as the deciding factor. The days of adding elements from system reviews, physical exams, and histories are over, reducing the weight of documentation needed.
These guidelines for document updates will be expanded to include the following:
- Inpatient
- Nursing facilities
- Residential settings
- Home observation units in 2023.
If you do not work in these environments, continue to code using the 99202–99215 range as in the past two years.
If you bill by the hour, all time spent on a patient’s case, excluding emergency room visits, will count towards your billing time. Note that your selection of E/M code for add-on therapies must be based on MDM.
Long-Term Changes in Service CPT Coding 2023
Sixty-eight psychiatry CPT codes will be discontinued in 2023, with only six being significant to outpatient psychiatrists.
CPT® will eliminate the prolonged codes 99354, 99355, 99366, and 99357. These were codes for prolonged face-to-face care that could be used in conjunction with inpatient, observation, or nursing facility codes and office/outpatient codes.
While many commercial payers and Medicare do not pay for these codes, CPT® is retaining the non-face-to-face prolonged care codes 99358 and 99359 for services provided on a different date from a face-to-face visit.
Therapists who conducted sessions longer than an hour for specific forms of psychotherapy, such as ketamine-assisted psychotherapy, used the deleted prolonged service codes. However, only psychiatrists and mental nurse practitioners can now use the codes that replace the prolonged service codes. Instead, the G2212 prolonged service code should be used for Medicare in the outpatient setting for intervals of 15 minutes.
When using time-based codes, accurately record the start and end times of face-to-face interactions and any non-face-to-face clinical duties completed on the same day.
Outpatient psychiatrists may occasionally use the other codes that will be abolished in the psychiatric billing codes 2023. These two low-level consult codes, 99421 and 99251, were rarely used in the medical industry.
Codes for Digital Health
With the advancement of remote physiological monitoring (RPM) and digital health, RPM codes were first established in 2019. In 2022, the AMA introduced new codes that went beyond physiological measurements taken remotely, such as vital signs. These new guidelines include provisions for comprehensive remote treatment monitoring (RTM), medication adherence and reaction, and participation in licensed digital therapy programs for mental health practitioners. The current RTM codes 98980 and 98981 are the ones that apply to psychiatrists the most.
The RTM code 98978 debuted in 2023 and is designed to track cognitive therapy for various physical and mental health conditions. Companies such as Pear Treatments have incorporated digital therapeutics for issues like substance use disorder and insomnia that these codes may cover.
Suppose you’re planning on offering RTM services. In that case, it’s crucial to check with any commercial payers you have contracts with to determine if these codes are included in your agreement, given the relatively new nature of this field.
In 2023, AI will also play a significant role in healthcare. The American Medical Association is starting to contemplate the potential impact of artificial intelligence on medical billing.
The mental health CPT codes 2023 set incorporates innovation. It incorporates Appendix S, a taxonomy that provides guidelines for classifying the use of augmented intelligence or AI in the medical field. The coding system is not yet fully established, but the AMA staff is already preparing for the future.
Final Thoughts
The American Medical Association’s coding changes aim to make life easier for doctors by staying current with the evolving “language of medicine.” Although diving into coding changes can be intimidating, focusing only on the codes that are relevant to your field can make the process less overwhelming.
For psychiatrists, the CPT® coding system is relatively straightforward. The 2023 modifications to psychiatric billing codes 2023 are relatively modest compared to the substantial changes made in 2021. This updated information should make it easier for you and your patients to bill and document treatments properly. Additionally, utilizing a psychiatry-specific EHR can be beneficial for the success of your clinic.
