AMA revises psychiatric procedure codes for 2013

The American Medical Association revised coding options for psychiatric evaluations, psychotherapy and pharmacologic management services, effective Jan.1, 2013.

The chart below indicates how you should now bill these services to BCBSM. Please use the 2013 Current Procedural Terminology coding guidelines when billing these services.

BCBSM reimbursement guidelines
The new psychotherapy codes will be reimbursed at the maximum payment amount based on the current Blue Cross Blue Shield of Michigan fee schedule. The maximum payment amounts for these procedures will be revised during the BCBSM annual review process of all procedures. The updated fee schedule will be available to view April 1 and become effective July 1, 2013.

Psychotherapy add-on codes (noted in the chart) billed with primary psychotherapy codes or evaluation and management codes will be reimbursed as psychiatric services.

When a psychotherapy service is performed during the same session as an E&M service, providers should report the new CPT psychotherapy add-on code in addition to the appropriate E&M service. The psychotherapy add-on code will be rejected if the associated E&M and primary psychotherapy procedure is not reported.

Pharmacologic management should be billed using the appropriate office visit code by physicians who have medication management within their scope of practice. E&M procedure codes billed with psychiatric diagnoses will process as psychiatric services.

For members who do not have mental health coverage through BCBSM, please send E&M procedure codes billed with psychiatric diagnoses to the appropriate mental health care carrier.

We are working diligently to correct the following billing issues:

• Two copays may be applied incorrectly to claims billed with an E&M code and a psychotherapy add-on code (when billed with a primary psychiatric diagnosis). The E&M code will apply an office visit copay, and the psychotherapy code will apply a psychiatric copay. When this occurs, the physician or member may call BCBSM to request an adjustment of the claim. The physician payment will be based on our current fee schedule.
• Claims may be rejected for members who do not have office visit coverage, if an E&M code is billed with a psychiatric diagnosis. When this occurs, the physician or member may call BCBSM to request an adjustment to the claim. If the member has psychiatric coverage, the claim will be reprocessed based on the member’s psychiatric benefits. If the member does not have psychiatric coverage, the rejection will be maintained.
• Claims may reject for psychotherapy procedure codes (billed prior to Feb. 7, 2013) *90785, *90791, *90832, *90834, *90837, *90839 and *90840 when billed by a clinical licensed master’s social worker. When this occurs, the physician or member may call BCBSM to request an adjustment to the claim. If the member has psychiatric benefits, the claim will be adjusted. If the member does not have psychiatric benefits, the rejection is correct, and the claim will not be adjusted.

If you have questions or experience any additional problems, please contact Provider Inquiry or your BCBSM provider consultant.