Health inSite: Coding changes signal shift in healthcare thinking

I was recently on a call with a partner of ours discussing the changes in coding established by the AMA known as Current Procedural Terminology (CPT) codes as of January 1 of this year.  These are the codes that allow claims to be submitted quickly and easily without needing heavy-to-lift, unstructured data such as clinical notes.  A very common code for psychotherapy previous to this change was CPT code 90806 (Individual Psychotherapy, 45-50 minutes).  The new code that most closely matches is code 90834 (psychotherapy, 45 minutes with patient and/or family).  The reason we were on the call was to deal with an issue that had come up where one group was asking for additional details to help resolve that this code was not being used for family therapy (an expressly excluded benefit under that particular plan).  It was following this call that, wanting clarification and to confirm my suspicions, I began looking into why the coding had changed at all.  I don’t work in claims, and these topics very rarely touch me, so I haven’t stayed 100% on this issue.

So, as I began searching for reasons why the change occurred, I found a couple of interesting things.  The first was the American Psychiatric Association’s crosswalk of CPT codes which confirmed our thinking that the 90834 was intended to replace code 90806.  The second, and more interesting thing I found was a PowerPoint presentation developed by the AMA which explains the coding usage through examples (slides 29-34) and an explanation for the change (slides 18-20).  It’s stated that the reasons for the change are:

1. The site is no longer relevant to the CPT code to be used.
2. To match the time-bounding of the codes for other areas of the CPT dictionary.
3. Psychotherapy may include face-to-face time with family members as long as the patient is present for part of the session.

Slides 29 and 32 provide very instructive examples of a much larger issue that these new codes hope to achieve going forward – they are systems-oriented.  This is a big step!  Effectively, the AMA has recognized that the treatment plan as well as the acuity of a given Behavioral Health issue may either stem from, or may be treated in some way by, the system in which the patient operates.  Now it may only be the family unit so far, but I wonder if this may signal a slight shift in the fee for service (FFS) model that may help erode the need for classifying treatment for the purpose of reimbursement; it may even signal the eventual demise of a FFS model altogether.  In any case, it at least begins to push the reimbursement model toward considering systems-based psychotherapy which relies on support systems like the family to achieve treatment adherence.

Further, inclusion of the family unit in the psychotherapy model is a slight tip of the hat to shared health responsibility.  It doesn’t necessarily follow that we’re moving to a true “your friend’s friends make you fat” approach to health, but by bringing the family into the individual treatment setting means sharing in the health of the patient; some responsibility is shared with that family member to report on successes and failures, and help guide that patient down the path to greater health.  If that relationship were reciprocal, and as we know to some level that might be the case given link influence, then this step into the 90834 might start to have greater effects than was originally anticipated.

To our health,

Ryan Lucas
Supervisor, Marketing