2013 CPT Code Glitch Threatens Mental Healthcare Providers

2013 CPT Code Glitch Threatens Mental Health Providers

Recent changes to the psychotherapy treatment codes used to bill patients and insurers is causing computer glitches that have the potential to affect hundreds of thousands of mental health professionals and millions of Americans with behavioral health issues.

For the first time since 1998, there has been major changes made to the CPT–or Current Procedural Terminal–codes included in the Psychiatry section of the American Medical Association’s manual. As many third-party payers such as Medicare and Medicaid work to update their coding, mental health practices are left waiting to receive payments until the codes are updated.

Usually, the codes are updated each year without any major, widespread problems. This year, however, 30 code changes have turned into a myriad of problems.

Denied insurance claims and withheld payments may limit the amount of time some practices will be able to keep their doors open. Marc Milhander, a psychologist based in Niles, Mich., told NBC News that he was forced to write a check from his personal bank account to keep his practice from going under. Milhander’s office is safe for now, but experts say these billing issues could continue for months.

Many of the changes to the CPT coding were implemented to simplify and expand the way mental health care providers record time with their patients–specifically in cases where a third party is needed to assist the patient or in crisis situations.

In October, the American Psychological Association Practice Organization released a special issue of their magazine, Good Practice, focused entirely on preparing members on the code changes. The publication seems to have missed it’s mark,however, as visits to the coding section of the APA’s website surged to over 300,000 in January.

Experts predict that the glitch could take months to fix. This could mean trouble for the 500,000 plus providers nationwide and the millions of Americans suffering from mental illness.

Many private insurers are doing their part to help those affected by the situation. Some are offering alternate methods of payment until the glitches are sorted out.

Unfortunately, many mental health care providers do not have the means to wait it out. Some providers are no longer accepting patients from certain insurers. Other practices may have to close their doors.

As recent events have thrust mental illness and mental health care into the spotlight, the CPT code glitch is wreaking havoc at seemingly the worst time.


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