2013 The Year of Change

Good bye to our standard 90862 and 90807 CPT codes. Many changes are occurring in mental health this year. The first changes occurred on Jan 1, 2013 with CPT codes being eliminated for mental health. This means that all psychiatrists will have to use the same codes that all other physicians use. This has resulted in having to use multiple codes to replace a  prior single code. As with most policy changes, this was implemented with good intentions but potential negative unintended consequences. This change was intended for psychiatrists to better document the complexity of treatment provided. Thus far it has created winners and losers depending on your insurance carrier. Many companies were not ready for this change despite at least six months advance notice. Problems thus far include rejecting the new valid codes, double copays charged to a patient for a single visit and delays in processing claims. If you are experiencing any of these problems, you may contact your insurance company to file a complaint and request reprocessing. You may also consider notifying your human resources department if you have a group insurance plan. The insurance commissioner for the state of California may be reached at 1-800-927-4357 or  written correspondence may be sent to California Department of Insurance, Consumer Services Division, 300 South Spring Street, South Tower, Los Angeles, CA 90013. Web site info can be found at www.insurance.ca.gov; click on request for assistance.

Next stay tuned for updates on the latest edition of the DSM-5, Diagnostic and Statistical Manual of Mental Disorders, released in May 2013. In 2014 the ICD codes will be changing potentially increasing the number of codes to 68,000 from the current 13,000 in the ICD 9. The code set will be expanding from 5 positions to 7. In addition 2014 is the official start date of The Patient Protection and Affordable Care Act. The preceding transitions are unlikely to be smooth despite all the promises.