New CPT Codes Promote Interventions

By Worcester, Sharon | Clinical Psychiatry News, November 2007 | Go to article overview

New CPT Codes Promote Interventions


Worcester, Sharon, Clinical Psychiatry News


Two new health care codes for substance abuse screening and brief intervention set to take effect Jan. 1, 2008, will "strengthen the doctor-patient relationship and incorporate a powerful preventive public health resource in America's health care system," according to the White House Office of National Drug Control Policy. But the medical community appears to be taking a wait-and-see approach.

Reimbursement for the new Current Procedural Terminology (CPT) codes (99408 and 99409) is a key concern among physicians informally polled about these new additions. The existence of codes does not ensure payment for the codes, and it is unclear whether the codes will be accepted by insurers.

"The key issue is not whether there are new CPT codes, but whether insurers and Medicare will pay for them, and could they be added to other CPT codes at the same visit," said Dr. David Spiegel, Willson Professor and associate chair in the department of psychiatry and behavioral services at Stanford (Calif.) University.

The potential value of these services for patients is another concern; some physicians question the value of "brief interventions" for substance use.

Dr. Jon O. Ebbert, an internist at the Mayo Clinic, Rochester, Minn., said years of either inadequate or no funding at all have left limited resources for physicians to refer to. In light of that, it seems that "the government is putting the cart before the horse" with the new codes, he said.

Similarly, Dr. Lee H. Beecher, a psychiatrist in private practice in St. Louis Park, Minn., said it would be encouraging to see evidence that adding such codes will change clinical practice.

"We already have too many CPT codes in medicine and fewer for mental health services, because our procedures are described as evaluation, psychotherapy, pharmacotherapy, [electroconvulsive therapy], and inpatient care management," said Dr. Beecher, also an adjunct professor of psychiatry at the University of Minnesota, Minneapolis.

"Psychiatrists sell time to the government. We are paid the same with no account of the patient's responses. This drives the common denominator to its lowest level and encourages 'upcoding' of work [intensity]."

Dr. Beecher said psychiatrists are currently being paid a low rate by Medicare for patient encounter time, so specifying the content of clinical interventions "will lead to the frustration of obsessive paperwork and whip cracking from clinic managers for 'productivity.'"

The new codes (99408 for interactions of 15-30 minutes, and 99409 for interactions over 30 minutes) were issued by the American Medical Association in October. …

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