CPT

Code Changes

Note: there are no changes to the CPT codes used by psychiatrists for 2012.

Changes for 2011 [posted 1.25.11]

There are two new codes in the Psychiatry Section of CPT for 2011, both for transcranial magnetic stimulation (TMS): 

  • 90867 – Therapeutic repetitive transcranial magnetic stimulation treatment; planning

(CPT 90867 may be reported only once per course of treatment, and may not be reported in conjunction with codes 95928 or 95929); and

  • 90868 – Therapeutic repetitive transcranial magnetic stimulation treatment; delivery and management per session.

CPT 90867 is to be used for billing the initial treatment planning session, where the parameters of the treatment are determined. CPT 90868 is to be used for billing the delivery of TMS treatment(s) either on the first treatment day or subsequent treatment sessions. When, during the course of a TMS treatment, a subsequent motor threshold redetermination is done, CPT 90899 (unlisted psychiatric service or procedure) should be used accompanied by documentation describing the redetermination process.

Formerly Category III codes (0160T and 0161T), CPT 90867 and 90868 are effective for claims with dates of service beginning January 1, 2011.  In the Medicare Physician Fee Schedule posted on the CMS website November 2, 2010, CMS states in the final rule that “due to the timing of the creation of these codes, the AMA RUC was unable to provide work and PE recommendations for CY 2011. As a result, these codes will be contractor priced for CY 2011.” What this means is that although the codes have changed from Category III to Category I, for 2011 APA members providing TMS will have to continue to work with payers individually to establish reimbursement rates. For hospitals, CMS has crosswalked the new Category I codes into the same APC where the 2010 Category III codes resided.  They are in APC 0216 and will be paid at a rate of $186.17 for CY 2011 in the hospital outpatient payment system.  

Note:  The AMA CPT (2011) publication incorrectly refers clinicians to the Category III codes.  An errata noting this error is posted on the AMA CPT website.

The APA submitted some additional changes for the 2012 coding cycle to the CPT editorial panel and a new AMA RUC survey of TMS procedures was conducted by the APA as part of the normal valuation process for new Category I CPT codes.   Decisions regarding these changes and final RVUs will not be made public until fall of 2011.  


APA Coding Network

The APA's Office of Healthcare Systems & Financing maintains a CPT coding network to answer members’ specific coding questions, and is actively involved in making sure that members are correctly reimbursed for the services they provide.  Because CPT questions are very specific and often very complex, a protocol has been established for queries to ensure that there will be no misunderstanding.

APA members with CPT coding questions should:

  • Write an e-mail or memo with name, APA member number, city, state, phone number, fax number, and e-mail address.
  • State the question or describe the problem thoroughly, but succinctly—a short paragraph is usually all that is necessary.Include any relevant correspondence from Medicare carriers, insurance companies, or third-party payers.
  • Cite any actions that have been taken relating to the problem, i.e., calls made, letters written.
  • E-mail (hsf@psych.org), fax (907-703-1089), or mail (Office of Healthcare Systems and Financing, APA, 1000 Wilson Boulevard, MS 1825, Arlington, VA, 22209) the question to the attention of Rebecca Yowell.

All questions will be answered as quickly as possible.

Courses/Workshops

APA Annual Meeting Courses and Workshop – CME courses devoted to general CPT coding and CPT coding using evaluation and management codes,  as well as a CPT workshop will be presented at the 2012 APA Annual Meeting in Philadelphia.  Course dates and times are listed in the 2012 Preliminary Course Brochure

CME Course:
Current CPT Coding and Documentation Requirements, Ronald Burd, M.D. Director
Intermediate CPT Coding: Evaluation and Management (E/M) Codes in Depth

Workshops:
Annual Meeting Workshop dates and times are listed in the 2012 Preliminary Course Brochure.

Procedure Coding Handbook for Psychiatrists, Fourth Edition,  Chester W. Schmidt, Jr., M.D., Rebecca K. Yowell, and Ellen Jaffe.