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CPT Coding, DSM-5, & ICD-10 Information

The last few years have brought major changes to the way psychiatrists diagnose, code and bill for their patients' treatment. 

CPT Coding

Recent changes to CPT coding for psychiatrists, particularly concerning Evaluation and Management (E/M) codes, have aimed to simplify and streamline the documentation process while enhancing the accuracy of billing practices. These revisions focus on reducing the administrative burden by allowing psychiatrists to select the appropriate E/M service level based on either medical decision-making or total time spent with the patient on the day of the encounter. This shift emphasizes the complexity and nature of psychiatric care rather than just the quantity of tasks performed. Now, E/M codes are selected based on medical decision making or based on total time spent. 99201 and 99211 were removed.

Selecting E/M Services Based on Medical Decision Making:

2 out of 3 of the following elements must be met or exceeded to qualify: number and complexity of problems addressed, amount and/or complexity of data to be reviewed and analyzed, risk of complications and/or morbidity or mortality of patient management. Then determine the level of complexity: straightforward, low, moderate or high. 

Level of Medical Decision Making Number of Diagnoses or Management Options Addressed Amount and/or Complexity of Data Reviewed and Analyzed Risk of Complications and/or Morbidity or Morality of Patient Management
Straightforward (99202 or 99212)  Minimal
• 1 Self-limited problem or minor		 Minimal or None Minimal
Low Complexity (99202, 99213)

Limited
• 2 or more self-limited or minor problems; or
• 1 stable chronic illness,
• 1 acute, uncomplicated illness or injury

 Limited (Must meet 1 of 2 categories below)

Category 1: Tests and Documents:
• Review of prior external note(s) from each unique source;
• Review of the result(s) of each unique test;
• Ordering of each unique test
Category 2: Assessment requiring an independent
historian(s) 

 Low Risk
Moderate Complexity (99204, 99214) Moderate
1 or more chronic illnesses with exacerbation, progression or side effects of treatment,  or
• 2 or more stable chronic illnesses, or
• 1 undiagnosed new problem with uncertain prognosis, or
• 1 acute illness with systemic symptoms, or
• 1 acute complicated injury

Moderate (Must meet 1 of 3 categories below)

Category 1: Tests, documents, or independent historian:
• Review of prior external note(s) from each unique source;
• Review of the result(s) of each unique test;
• Ordering of each unique test • Assessment requiring an independent historian(s)

Category 2: Independent interpretation of tests performed by another physician

Category 3: Discussion of management or test interpretation with external physician/other QHP/ appropriate source 

Moderate

Examples:
• Prescription drug management
• Diagnosis or treatment significantly limited by social determinants of health
High Complexity (99205, 99215) High 

1 or more chronic illnesses with severe exacerbation, progression, or side effects of
treatment; or
• 1 acute or chronic illness or injury that poses
a threat to life or bodily function

High (Must meet 2 of 3 categories below)

Category 1: Tests, documents or independent historians:
• Review of prior external note(s) from each unique source;
• Review of the result(s) of each unique test;
• Ordering of each unique test
• Assessment requiring an independent historian(s)

Category 2: Independent interpretation of tests performed by another physician

Category 3: Discussion of management or test interpretation with external physician/other QHP/ appropriate source

High

Examples:
• Drug therapy requiring intensive monitoring for toxicity
• Decision regarding hospitalization

 

Selecting E/M Services Based on Time:

Selecting your code based on time includes both face-to-face and non face-to-face time spent by the clinician (does not include time spent by clinical staff), including the time spent documenting clinical information in the record, taking collateral, reviewing records, etc. Time can be used with or without counseling and/or coordination of care.  If selecting codes based on time, the time spent must be documented in the record. This can be done through including start and stop times or indicating total time spent.

New Outpatient E/M Codes

CODE 99202 99203 99204 99205
TIME 15 minutes 30 minutes 45 minutes 60 minutes

 

Established Outpatient E/M Codes

CODE 99212 99213 99214 99215
TIME 10 minutes 20 minutes 30 minutes 40 minutes

  

Documentation

In 2021, changes to E/M coding went into effect that require only the medically necessary and appropriate portions of history, review of systems, and physical exams are required in an effort to reduce the documentation burden and make it easier to find pertinent information within the record.

DSM-5 Resources

ICD-10 Resources

The 2021 release of ICD-10CM Includes new, updated or deleted codes for medical conditions. A handful of these changes pertain to medical disorders that go into effect October 1, 2021.Download a quick-reference guide to the changes

The CDC has updated the ICD-10-CM with 11 new diagnosis codes describing social determinants of health. These new Z codes were created to provide additional information regarding data such as housing, food insecurity, or transportation. 

View the Changes Here