What is a CPT Code and

Does it Matter?

Free Summer Tuesdays webinar with

Karen Allen CCH www.karenallenhomeopathy.com

What Is IT????

● CPT: Current Procedural Terminology

● A code assigned to every task or service that a healthcare practitioner may provide for a patient or client – like a barcode on that container of hummus

● Ensure uniformity to simplify documentation of services provided and insurance reimbursement

● Developed, maintained copyrighted by the AMA since 1966, and updated annually

● You can buy the CPT book (2013) for about $75, not freely available

Gimme an example?● A CPT code is a 5 digit number

– 99201 is an initial evaluation for a new client at a practitioner's office

– Some have a letter in the last position– Any practitioner can use them– Medicare calls them HCPCS codes (but

they're the same from the client's viewpoint)

● NOT THE SAME AS AN ICD9 or ICD10 code.

– These have decimal points in them: 530.81– They represent a diagnosis– They can only be assigned by a licensed

practitioner who diagnoses clients

How Do I Find Them?

Looking One Up?● From the AMA website

– Set up for patients/clients– Agree for personal use– Put in a code or a word– Refer clients to this if they want to know...

Likely Options for Homeopaths to use?

● Office visit for evaluation and management

– 99202 / 99203 / 99205 for 20 / 30 / 60 minutes for initial consult

– 99214 / 99215 / 99215 for 25 / 40 / 60 minutes for follow up consult

– 90832 / 90837 / 90838 for 30 / 45 / 60 minutes (specifically noted as psychotherapy)

– This is the coding most often used by counselors / psychotherapists

● A consult for new or follow up client:

– 99242 / 99243 / 99244 / 99245 for 30 / 40 / 60 / 80 minutes

Options in Preventive Care?● Office visit for a mental/

emotional/ behavioral complaint H0046 (Mental health services, not otherwise specified)

•A Preventive care consult by age group:•99381 / 99382 / 99383 / 99384 / 99385 / 99386 / 99387 for <1yr, 1-4yo,5-11yo, 12-17yo, 18-39yo, 40-64yo, 65yr> for preventive care initial consult

•99391 / 99392 / 99393 / etc same for follow up

How do we do these things as homeopaths?(non-physician)

Does It Matter? ● We are obligated to provide our clients with a statement

that can be submitted for insurance reimbursement– CPT code required (we can select this)– ICD9 code required (Client must provide from

his/her primary care provider)– See example of instructions to clients at

www.karenallenhomeopathy.com (consultation)

● We are building the recognition of our emerging profession - we serve our clients by cooperating with the health care infrastructure

But.... Darn...These Codes Are NOT a Perfect Match for Us!

● Or for our clients. Or researchers. Or regulatory and policy makers.

● Because they do not correlate well with all of the holistic modalities that clients seek out

● Homeopathy is never mentioned in the CPT codes

Limitations of CPT?

“There is much more to these codes than just billing. Practitioners use them for medical record-keeping and practice management; health plans use codes to process insurance claims and to design and manage benefits.”

“Researchers use them to identify what type of care works best, and actuaries use codes to help make public policy decisions for our national health care system. So without codes for natural healing arts services we are not able to document the effectiveness of care or the money that is saved by using them. It's a lose-lose situation.”

Carolyn Dean, MD, ND

ABC codes

ABC codes

www.abccodes.

com

Homework Time Again...

● Download the supporting documentation for this webinar from www.karenallenhomeopathy.com under the training tab

● Read through the CPT codes and ABC codes and select those that apply to the services you provide

● Update your paperwork – specifically, the 90804 / 90805 / 90806 / 90807 / 90808 / 90809 codes have been retired

● Educate clients about the ABC codes; consider including them on your paperwork for clients to increase visibility

● Affirm that you will only include ICD9 and ICD10 codes with the name/contact of the diagnosing practitioner

Questions?● What do you think?

● Thanks for your participation!

● See you at the next Free Summer Webinar on July 18: Threshold for Client Participation in Homeopathy

Let's change the world together – one practice at a time, one client at a time, one case at a time, one student at a time, one lifetime well spent...

www.karenallenhomeopathy.com

Webinar: What are CPT Codes and Does It Matter? June 18, 2013

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