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IMA Admin Update
December 7, 2012
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2013 Psychotherapy CPT codes - Update 2
Medicaid has finally spoken and we now know how they plan to implement the changes in CPT coding scheduled to go into effect on January 1,2013. Click below for detailed documentation from OMH.
OMH Cover Letter for CPT 2013 Changes
OMH Crosswalk for CPT 2013 Changes
IMA has finalized the details of the changes that we will be releasing next week to support this. When released we will schedule a webinar to review but in preparation for that, here is a preview.
Activity codes
It is important to review all activity codes used in the clinic along with their CPT code mapping. When reviewing, please note that the CPT code used in a claim may vary for different payers. The fields on the billing tab of activity code definitions are; "Medicare rate code", both "Other Insurance codes", and "CPT code". Each might be used in different billing situations. When reviewing, the focus should be on:
1. Activity codes that just need their CPT mapping changed. This would be applicable when the service provided is not changing and just the CPT code used to describe it has changed.
2. New activity codes that need to be added. This would be applicable for new services not previously provided.
For mapping changes, you simply need to change the activity codes to point to the new CPT code prior to 1.2.2013.
However, in order to enable these same activity codes to bill with the OLD CPT codes for dates of service is prior to 2013, please share the mapping with the IMA helpdesk and we will be able to configure a crosswalk for "OLD" dates of service.
For new activity code, please add them as needed making sure to also add all fee schedules that they are linked to.
CPT Code Table
Make sure to add any new CPT codes to the CPT Table
Progress notes
There are a few cases where OMH is suggesting that a single service be coded with two CPT codes. A Psychiatric Assessment is supposed to have an E & M code along with an add-on CPT code. These can currently be posted in progress notes using the "Secondary services" feature.
Billing and Remittance
The IMA billing and remittance programs are being updated to include the logic to allow the same Activity code to be billed with different CPT codes depending on the date of service.
Managed Care Service Authorizations
Some managed care companies issue service authorizations for specific CPT codes, please review these to ensure both the new and old CPT codes are accounted for.
Training of clinicians and clerical staff
If new activity codes are being used, please make sure to communicate with clinical and clerical staff to make sure they how and when to use them.
Other Issues and Questions It is our understanding that most commercial insurances will be following the OMH rules. If you encounter specific cases where this is not the case, please send details directly to Barry (zevi@imasys.com)
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