From the Practice Directorate

Two changes in the Current Procedural Terminology (CPT®) book for 2008 may help psychologists bill properly for the services they provide effective January 1. CPT 2008 incorporates clarifying language that describes when to use the codes for psychological and neuropsychological testing.

Do These Coding Book Changes for 2008 Affect Your Practice?

Two changes in the Current Procedural Terminology (CPT®) book for 2008 may help psychologists bill properly for the services they provide effective January 1. CPT 2008 incorporates clarifying language that describes when to use the codes for psychological and neuropsychological testing. The book also includes new CPT codes for team conferences involving non-physicians.

Clarification about the Testing Codes
Earlier this year, the APA Practice Organization (APAPO) asked the CPT Editorial Panel to add clarifying language to the CPT codes for psychological and neuropsychological testing. APAPO made this request to resolve confusion among billers, compliance officers and insurers about appropriate use of the 96101 and 96118 codes for psychological (96101) and neuropsychological (96118) testing by the psychologist, with interpretation and report.

New language in CPT 2008 clarifies that the 96101 and 96118 codes also can be billed for time the psychologist spends integrating other sources of clinical data, including previously interpreted results and information from tests that were administered by a technician or computer, into a report. In asking for the clarification, APAPO asserted that integration of test results and other sources of clinical data is a different service than administering, interpreting and reporting on individual tests.

Importantly, this clarification does not represent a Medicare or other policy change nor does it change the way that these testing codes are intended to be used. The new language does not change any existing Medicare billing rules such as the need to append modifier 59 to the technician and computer-based testing codes when they are billed with the professional code for the same patient on the same date of service.

The 2008 coding book also makes it clear that the time a psychologist spends interpreting and reporting on each individual test administered by a technician or computer is still paid for under the relevant technician- or computer-administration codes (96102/96119, and/or 96103/96120).

New Team Conference Codes Available to Psychologists
Beginning in January 2008, psychologists may bill two new codes for team conference services when practitioners are involved in meetings of at least 30 minutes between interdisciplinary professionals from at least three disciplines to assess a patient’s care plan and progress. The team conference codes, 99366 and 99368, are specifically intended for use by non-physician practitioners. In the past, similar CPT codes were available exclusively to physicians.

As one example, a psychologist, occupational therapist and neurologist may meet for 45 minutes to discuss health and behavior interventions for a hospitalized Medicare beneficiary who is recovering from a stroke. The psychologist and the occupational therapist can each bill the relevant team conference code: 99366 if the patient is present; 99368 if the patient is not present.

In another change, the CPT Editorial Panel approved a new code for standardized cognitive performance testing for use by occupational and physical therapists. The code’s descriptor specifically states that it is not for use by psychologists, who will continue to use the codes for psychological and neuropsychological testing. CPT 2008 books can be ordered from www.amapress.com or by calling (+1/800) 621-8335.


APA Survey Finds Rising Stress Takes A Toll

The results are in: Americans are increasingly stressed out, and it’s affecting their health, work and relationships. Results from “Stress in America,” the American Psychological Association’s annual national survey of attitudes and perceptions of stress among the general public, were released on October 24, 2007.

Among the survey findings:

Some stress is to be expected, but too much stress can make us sick.
Stress is a fact of life, say 79 percent of those surveyed, and 73 percent believe that too much stress can make you sick. During the month preceding the survey, 77 percent of Americans experienced stress-related physical symptoms including fatigue, headache and upset stomach. And 73 percent reported psychological symptoms including irritability or anger, feeling nervous and lack of energy.

We’re most stressed about work and money.
Work (74 percent) and money (73 percent) cause the most stress, followed by workload (66 percent), children (66 percent) and family responsibilities (60 percent). And we’re more stressed about work and money than we used to be—last year, 59 percent called each a stressor. Housing is a major stressor on the nation’s coasts. Housing costs, including rent or mortgage payment, were cited as a significant source of stress more often in the West (62 percent) and East (55 percent) than the Midwest (47 percent) and South (43 percent).

Stress is damaging our personal relationships.
Roughly half of all Americans (45 percent) report that stress has a negative impact on their relationship with a spouse or partner. A third (32 percent) report fighting or arguing with a spouse or partner in the last month, and one in four (25 percent) say that during the last five years their personal relationships have suffered because of stress.

We rely on unhealthy behaviors to manage stress. When they feel stressed, Americans drink more alcohol and smoke more cigarettes: 66 percent of smokers report smoking more when stressed and 17 percent of people who drink reported drinking too much in the week before being surveyed due to stress. In the month before being interviewed, stress compelled nearly half (43 percent) to overeat or eat unhealthy foods (with candy and ice cream leading the snack pack) and more than one third (36 percent) to skip a meal.

We know the value of psychotherapy and exercise in managing stress, but we don’t follow through.
Sixty nine (69) percent of those surveyed recognize the benefits of mental health support in stress management, but only 7 percent sought professional help to manage their stress in the past year. And while respondents report walking or running to relieve stress, more choose sedentary activities, including listening to music and reading. The survey results were first announced exclusively by USA TODAY, which devoted nearly a full page to coverage, and NBC affiliates around the country. Journalists from more than a dozen additional media, including The New York Times, Reuters, The New York Post, Good Housekeeping, Ladies’ Home Journal, Reader’s Digest, Prevention and Women’s Day magazines, gathered at a press luncheon event in New York with APA Executive Director for Professional Practice Russ Newman, PhD, JD. Division 38 (Health Psychology) President Beverly E. Thorn, PhD, also presented survey results and addressed the physiological effects of stress. Richard Millard, PhD, MBA, presented the survey methodology (see below) on behalf of Harris Interactive.

In the early hours after release, the survey results stimulated considerable interest among the media. Dr. Newman interviewed with NBC Nightly News and MSNBC on October 25, and Dr. Thorn conducted radio interviews.

The survey is a component of APA’s Mind/Body Health Public Education Campaign (PEC), which seeks to educate the public about the connection between psychological and physical health and promote the work of psychologists to improve overall health. Members of the public can access survey findings, as well as articles and tips for dealing with stress, at < href=http://www.apahelpcenter.org>www.apahelpcenter.org.

To support psychologists’ efforts to educate members of their local communities about the mind-body health connection, APA is offering members a free Mind/Body Health Toolkit.

The toolkit includes:

  • Overview of the campaign on DVD

  • PowerPoint presentations, discussion guidelines, tips on how to work with the media, template press releases and articles for consumers—all on a portable flash drive

  • Radio public service announcements and video news releases in support of the campaign

  • CD illustrating the physiological effects of stress via interactive anatomical figures

The free toolkit can be ordered by emailing the Campaign Services Bureau via Email. APA members who request a toolkit automatically become part of the PEC Network and will be connected to their state, provincial and territorial psychological association (SPTA) PEC Coordinator. The coordinator oversees public education initiatives in his or her SPTA and serves as a public education liaison to APA.

Note about methodology: “Stress in America” was conducted online by Harris Interactive on behalf of the APA. Between August 30 and September 11, 2007, 1,848 adults (ages 18 and over) were interviewed in English and Spanish on their attitudes and perceptions of stress. The survey has a sampling error of +/- 2 percentage points.