Just as precision is vital to diagnosing and treating medical matters, it is also vital to recording your practice’s procedures for coding and billing purposes. The AMA has developed educational resources which can help you understand the importance of correct Current Procedural Terminology (CPT®) and ICD-9-CM and ICD-10-CM diagnosis coding to ensure that your practice receives fair, accurate and prompt payment for services provided. The optimal coding process in any physician practice occurs when physician and coding professionals work as a team to accurately record the patient diagnosis and services provided.
For Current Procedural Terminology (CPT®) 2013 the codes and guidelines in the Psychiatry section have been revamped to more accurately reflect and differentiate the work performed by physicians and other qualified health care professionals, including the shifts of:
- site of service from the hospital to the office setting; and
- treatment of single disorders to the management of multiple medical co-morbidities.
The former code structure that was specific to site of service and the different types of services provided now no longer references the site of service. The current code structure now allows reporting of interactive techniques as an add-on service to the primary service.
Educational material on this topic is readily available at:
www.ama-assn.org/go/cpt. On this website, you can also view the webinar, “CPT® 2013 changes psychotherapy/psychiatric services” (free registration required).
Additional resources from various associations, compiled below, include summaries of the changes, FAQs and webinar opportunities.
- American Psychiatric Association
- American Academy of Child and Adolescent Psychiatry
- American Psychiatric Nurses Association
- American Psychological Association
- National Association of Social Workers
- Clinical Social Work Association
We encourage you to report HIPAA violations. Simply file a complaint through the Centers for Medicare and Medicaid Services website and/or through the online AMA Health Plan Complaint Form at
Adopting current electronic health care transaction technologies can help your practice lower administrative costs, reduce payment errors and save time. The AMA offers multiple toolkits to ease the process of automating your practice through the use of electronic health care transactions, including claims submission, eligibility requests and electronic remittance advices.
"Prepare that claim," and its companion resources "Follow that claim" and "Appeal that claim," were developed to help physicians and their practice staff to review the efficiency of their current internal claims management process as well as understand the payer’s role in the claims process. These resources contain sample forms and policies that can be adapted to fit the specific needs of a physician practice, including a sample encounter form—super bill.
Particularly as payers transition away from fee-for-service payment systems to budget-based payment methodologies like capitation, bundled payments and shared-savings programs, the accuracy of diagnosis coding will become as important as CPT® coding to ensure accurate payment. Diagnosis coding is critical to accurate risk adjustment, which is itself critical to ensuring that the budget against which the physician is being measured fairly reflects the morbidity of the physician’s patient population.
The differences between ICD-9 and ICD-10 are significant and physicians and practice management staff need to start educating themselves now about this major change so that they will be able to meet the October 1, 2013 compliance deadline.
CPT® Network is your resource for CPT® coding answers "straight from the source." This new system provides members and subscribers the tools to quickly research a database of commonly asked questions and clinical examples (vignettes). If the answer to a specific question cannot be found in the database, authorized users will have the capability to submit an electronic inquiry directly to CPT®. Our staff of CPT® coding experts is committed to providing users with timely and accurate solutions to their coding inquiries.
For your convenience, a variety of subscription packages have been designed. When reviewing the package options, please take into consideration the volume of coding inquiries your organization may require and the number of users that will need to access the service. Keeping these factors in mind, you can select the package which best fits your specific needs. AMA members receive a complimentary full-year subscription to the CPT® Network, including access to the Knowledge Base and six free electronic inquiries.
Once you become a user of CPT® Network, you will be just a click away from accessing the Knowledge Base (KB) or submitting an electronic inquiry (EI).
Sign up for CPT® email notifications – Receive email notifications when changes are posted to the AMA website for Category II codes, Category III codes, Vaccine codes and Errata.
Learn how to select a practice management system that will reduce your time spent on manual administrative tasks that occur throughout the claims revenue cycle and replace them with automated solutions.
Proper coding is critical to managing a practice's claims revenue cycle. However, the complexity can also be daunting. Knowing when and how to use codes and modifier ensures that your practice accurately records the services it delivers–and is paid fairly for those services.