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“Here Comes The Twist” 2013 CPT Coding Changes for Psychiatrists and Behavioral Health Providers

By April 3, 2013September 8th, 2021No Comments

We want to keep you apprised of the current status amidst stakeholders for the 2013 CPT coding changes for behavioral health providers. As a part of this, we want to point out, and help you recognize, issues you may come across with some of your payers…

There’s a new twist, it seems, in the claims question: to bundle, or not to bundle? On the Valant in-house billing team we’ve encountered a new situation, courtesy of some members of the Blue Cross and Blue Shield Association. Previously, we mentioned that the Blues were showing different, inconsistent levels of preparedness for the 2013 CPT code changes. This was most noticeable in the claim delays in processing the therapy add-on codes submitted for our psychiatry customers. It appeared several states, such as New York, Massachusetts and California, needed extra time to set up their systems to accommodate the new codes. That has happened in the past two weeks, but with the processing of the add-on codes, comes the twist.

Some Blue plans are stating that the E/M codes now required for psychiatrists are to be processed under the patient’s ‘medical’ benefits, and the add-on codes are to be handled under the behavioral health benefits for the member. As such, these payers are stating that two copays do indeed apply to any single visit performed by a psychiatrist that requires an E/M code and add-on code for proper documentation of the level of service. Additionally, front-line customer service reps for the payers are instructing our billing team to submit the E/M code to one payer for processing, and the add-on code as a stand-alone to another for “mental health benefits processing”. This demonstrates a lack of understanding of the definitions and instructions provided by the AMA, to behavioral health providers for 2013.

These situations, revealed on payer EOBs (two copays being assessed, denials or delays on payment of add-on codes), require the manual intervention of our billers. Through patience, and persistent explanation of the CPT code changes, and how an add-on code is defined, we are able to get most CSR’s to understand the situation and recognize that the claims need to be reprocessed. However, we do encounter roadblocks, and in these scenarios, we escalate our request to Provider Relations or Network Management. All stakeholders need to adhere to the requirements of the 2013 CPT code changes, and you and your patients should not be penalized for adopting the required changes. Together we can help bring the payers up to speed so that they too, do the right thing for psychiatrists.

AUTHOR: Heather Grube