Both the regulatory climate and the fiscal market in which mental health care is provided have continued to change since the first edition of Procedure Coding Handbook for Psychiatrists
was published in 1993. Now in its fourth edition, this handbook not only outlines how correct coding and documentation are vital to getting paid, but also helps avoid audits from insurers and provides protection against malpractice allegations through knowledge of the coding system. This manual provides essential coding and documentation guidance in an easy-to-read format, as well as:
Procedure Coding Handbook for Psychiatrists
- The collective wisdom of the American Psychiatric Association (APA) Committee on Resource-Based Relative Value Scale (RBRVS), Codes and Reimbursement and over 15 years of author experience.
- Specific psychiatric codes combined in one chapter for easy reference.
- Details on payment issues surrounding certain medical coding, as well as reimbursement issues common to major payers.
- A more thorough description of the level of code to select based on actual clinical examples.
- A complete list of codes most frequently used by psychiatrists along with descriptors.
is a concise, easy-to-reference text that offers greater clarity of the intricacies of coding and documentation than ever before. Chapters provide the following insights:
- Basic background information about Current Procedural Terminology (CPT) coding and a description of the format of the American Medical Association CPT manual so practitioners and students alike will know where to find appropriate codes.
- The importance of complete and accurate documentation for both good patient care and collective activities.
- Detailed descriptions of the psychiatric evaluation and therapeutic procedure codes as well as nonpsychiatric mental health services and an explanation of how to document them.
- Vignettes for different clinical sites and coding solutions appropriate for these vignettes.
- Frequently asked questions and problem scenarios based upon queries that have come through the APA’s Managed Care Help Line.
The need for a manual like Procedure Coding Handbook for Psychiatrists is greater than ever as mental health professionals continue to struggle with payers about the appropriate choice of codes for specific services and the relationship of the code chosen to the level of reimbursement. As payers continue to challenge the “medical necessity” of services by denying use of codes that have a higher reimbursement value, an in-depth knowledge of proper coding and the technicalities surrounding it is a must for clinicians, residents, and students alike.
Preface. Introduction. Basics of current procedural terminology. Introduction to documentation of psychiatric services. Codes and documentation for psychiatric services and other mental health services. Codes and documentation for evaluation and management services. Coding and documentation for specific clinical settings. Medicare. Commercial insurance issues. Putting it all together for accurate coding. FAQs and problem scenarios. Appendix A: The CPT coding system: how it came to be, how it changes. Appendix B: The Health Insurance Portability and Accountability Act (HIPAA). Appendix C: Modifiers. Appendix D: Place of service codes for Medicare. Appendix E: 1997 CMS documentation guidelines for evaluation and management services (abridged and modified for psychiatric services). Appendix F: Vignettes for evaluation and management codes. Appendix G: Most frequently missed items in evaluation and management (E/M) documentation. Appendix H: Documentation templates. Appendix I: ECT patient information, consent form, and record template. Appendix J: Examples of relative value units (RVUs) (2010). Appendix K: National distribution of evaluation and management code selection by psychiatrists. Appendix L: American Psychiatric Association CPT coding service and additional resources. Appendix M: Medicare carriers and administrative contractors. Appendix N: Centers for Medicare and Medicaid services regional offices. Index.
"Coding is a complex maze of concepts and categories that can bewilder the user. It is essential to code for services in an accurate manner. This updated edition of a classic handbook will clarify and educate all mental health professionals who bill for their services. It should be in all psychiatrists’ personal libraries. Nothing else matches the concise and systematic explanations of this ever changing process!"—Thomas N. Wise, M.D., Professor of Psychiatry at Johns Hopkins University School of Medicine, Baltimore, Maryland
"Since the mid-1990s, the most valuable resource for clinicians wanting to achieve insurance access to treatment for their patients has been the Procedure Coding Handbook for Psychiatrists. This Fourth Edition includes the many recent developments that we all need to know to make our documentation and claim submissions consistent with federal and state regulations. Beautifully done."—Roger Peele, M.D., DLFAPA, Chief Psychiatrist, Department of Health and Human Service, Montgomery County, Maryland.
"The Procedure Coding Handbook for Psychiatrists is much more than its name suggests. The authors have been involved in this work at the highest levels and their intimate knowledge is reflected in their in-depth analysis and direction. This book provides the background to understand where our current coding system comes from and gives clear direction to accurately code for the work done to most efficiently maintain this business aspect of a psychiatric practice."—Ronald M. Burd, M.D., current Chair of the APA committee on RBRVS, Coding and Reimbursement, past Speaker of the Assembly and psychiatrist with a clinical practice with Sanford Health in Fargo
Chester W. Schmidt, Jr., M.D.,
is founding member of the American Medical Association (AMA) Relative Value Scale (RVS) Update Committee, consultant to the American Psychiatric Association (APA) RVS Update Committee, and professor of psychiatry at the Johns Hopkins University School of Medicine in Baltimore, Maryland.
Rebecca K. Yowell is deputy director of the APA Office of Healthcare Systems and Financing in Arlington, Virginia, and lead staff for APA’s work with the AMA CPT Editorial Panel and AMA RVS Committee.
Ellen Jaffe is the Medicare specialist in the APA Office of Healthcare Systems and Financing in Arlington, Virginia, and is responsible for the Psychiatric Practice and Managed Care page that appears irregularly in Psychiatric News.