The Current Procedure Terminology (CPT) code set is used to denote the medical and surgical procedures and diagnostic services rendered by clinicians. The CPT coding system provides a uniform language for describing these services for all billing and documentation and, under HIPAA, is required to be used to record care by all health care professionals in the United States.
For the clinician, the key to appropriate insurance reimbursement lies in accurate procedure coding. Coding errors can lead to delayed payments or rejections of submitted claims. Consistent errors may trigger audits, or even charges of fraud and abuse, and removal from managed care networks. Always verify CPT information with the AMA's current CPT manual, which is the ultimate authority on procedure coding.
Procedure Coding Resources for APA Members
Update on 2021 Office/Outpatient E/M Billing and Documentation
CMS has finalized changes to the way office/outpatient E/M codes (99202-99215) will be chosen and documented. Note that the following changes apply only to the office/outpatient E/M services; continue to bill and document as you always have in all other settings.
APA Member-Only Resources
APA has created the following resources for its members on the 2021 billing and documentation changes. These are accessible by clicking the link below and signing in with your member credentials.
- Recorded Webinar: Update on 2021 Changes to Billing and Documentation for Outpatient E/M Services
- Webinar Slides
- Quick Guide to the 2021 Update to Billing and Documentation for Outpatient E/M Services
Evaluation and Management (E/M)
Practical Information on E/M Coding from Psychiatric News
Codes to Know
- Treatment of Smoking Cessation During Outpatient Psychiatric Visits – The guide provides psychiatrists with billing options using add-on codes and additional CPT codes when providing treatment for smoking cessation.
- Interprofessional Telephone/Internet/Electronic Health Record Consultation Codes – The billing guide and patient pamphlet provide guidance to psychiatrists and their patients on the use of the non-face-to-face consultation codes ("curbside consults"). Introduced in 2019, Medicare began paying for these in 2020. The codes are to be used when the patient's treating physician requests an opinion and/or treatment advice from a specialist.
- Online Digital Evaluation and Management Services Codes and Instructions – Instructions and details about three new codes for providing online E/M services to established patients who have not been seen in the past seven days for an E/M visit, and will not be seen in the next seven days for an in-person visit.
- Interactive Complexity Guide – Interactive complexity refers to 4 specific communication factors during a visit that complicate delivery of the primary psychiatric procedure. Report with CPT add-on code 90785.