CPT Codes and Billing Changes

CPT Codes and Billing Changes 2021

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In January of 2021 the AMA changed the way that physicians must choose the appropriate “CPT” or billing codes for outpatient visits. The changes simplify the process and also make it clear that we have been “undercoding” for psychiatric outpatient visits at Gateway Psychiatric for quite a while.

The reason for this is that the previous system for choosing billing codes was so complicated that it could take 5 or more minutes of clinician time choosing the right code for each visit. More importantly, it was almost impossible to explain to a patient why one code was selected over another. Similar sessions, lasting the same length, could have very different billing codes.

In the current revision, the code that we have been using for most visits with Dr. Peter Forster (99214 – or 99214 GT for telehealth appointments), is supposed to be used for visits lasting between 25 and 35 minutes. Many of Dr. Forster’s visits last much longer than 35 minutes.

After some soul searching, and not wanting to raise fees a great deal during the pandemic, we have decided to set the time cutoff for a higher billing code (a code associated with a higher charge) at 40 minutes. Sessions with Dr. Forster lasting longer than 40 minutes will be billed at a higher rate.

If patients take advantage of all the tools to prepare for visits, most sessions can be completed in under 40 minutes. To minimize cost, it will be important to do the following before your session:

  1. Fill out the pre-visit survey at least 24 hours before the appointment. Doing so means that your answers will be readily available to Dr. Forster without spending time searching online and copying and pasting the answers into your chart.
  2. When you fill out the survey, check your medication bottles to see if you have refills already written for. The question to ask yourself is whether, without any further approvals, you can get the refills that you will need before the following session. We have a blog post to help you with reading the labels on your bottles.
  3. Also when filling out the pre-visit survey think carefully about what you want to discuss in your meeting with Dr. Forster. Knowing that will allow him to reserve enough time for these discussions.
  4. If you are doing a mood chart, be sure to complete the mood chart entries daily. If you write them elsewhere and copy the results into the Google form, do that at least 24 hours before the appointment.

With these steps taken, the only reason your session should go over 40 minutes is because the questions you are discussing are especially complicated, or urgent, or serious. And in those cases a higher billing code is appropriate.

For More Information

Fee Schedule for Gateway Psychiatric

What is a CPT Code