National Psychologist January/February 2011

 

AMA seeks further review of psychotherapy codes

The National Psychologist (2011), Vol., 20, 1, p.18

By Paula E. Hartman-Stein, Ph.D.

            The Relative Update Committee (RUC) convened by the American Medical Association (AMA) did not accept the results of a nationwide survey taken last summer by more than 700 practicing psychologists, psychiatrists, clinical social workers and psychiatric nurse practitioners.

The survey was expected to impact reimbursement rates for psychotherapy set by Medicare and most insurance companies.

            According to James Georgoulakis, Ph.D., the APA representative to the RUC, “The committee had concerns over the data, especially whether the wording of the psychotherapy codes reflected the current practice of psychotherapy. As a result of these concerns the RUC believed it was in the best interest of all disciplines involved that the codes be sent to the Current Procedural Terminology (CPT) committee of the AMA for a further review.”

            The CPT committee develops the codes RUC will assign values to, which translate into payment rates for Medicare and most insurance companies.

            At press time APA had not submitted a statement explaining the outcome of the survey and the recommendations of the RUC.

            The Centers for Medicare and Medicaid (CMS) authorized the survey to examine the work values of more than 30 CPT codes for psychotherapy services. In addition to psychologists, survey participants included clinicians from the American Psychiatric Association, the National Association of Social Workers, the American Nurses Association and the American Academy of Child and Adolescent Psychiatry.

            According to an article in The Wall Street Journal, Oct. 26, 2010, the RUC is an influential committee, and CMS follows at least 90 percent of its recommendations.

            Tony Puente, Ph.D., who now has a vote on the 17-member CPT panel, represented APA on the CPT committee for about 15 years in an advisory capacity. He said the AMA recently convened a six-member planning work group to determine how the current practice of psychotherapy could better match the codes descriptors in the CPT manual.

            “The planning work group is close to finishing its work which will result in a change to a larger work group that will include several disciplines, not limited to psychology,” Puente said.

            The discussions of the planning group are confidential.

            APA will appoint a representative and an alternate to the regular work group that will have a deadline of six to 12 months to make recommendations to the CPT panel, according to Puente.

            Puente views the recommendation from the RUC to not accept the survey data and instead to overhaul the psychotherapy codes as a positive step for the field of psychology. “The codes had not been revised in a long time,” Puente said. “We hope the CPT codes will be revised to report more accurately what is occurring during psychotherapy. This process may result in a major paradigm shift for psychology.”

            Puente expects another survey will be conducted after the CPT family of psychotherapy codes is revised. “The system should not guide the practice of psychotherapy; the practice of psychotherapy should guide the system,” he said.

            The RUC recommended that the psychotherapy work values remain the same for 2011, according to Georgoulakis. “Reimbursement for psychotherapy in 2011 is based upon current work values on the Resource-Based Relative Value Scale (RBRVS), and any reduction in reimbursement is due to a reduction in practice expense, overheard expense, the geographical adjustment factor or the Sustainable Growth Rate (SGR).”

            Paula Hartman-Stein, Ph.D., is a clinical geropsychologist with a consulting practice in Kent, Ohio. She was a member of the Technical Consulting Group that participated in the design of the original national psychotherapy survey at Harvard in 1992. She may be reached through e-mail at paula@centerforhealthyaging.com or her website, www.centerforhealthyaging.com.