In the U.S. health-care system, being represented by a code in the procedural coding system is like--in some very tangible ways--having recognition of one's existence. That's why psychologists can celebrate some new Current Procedural Technology (CPT) codes, set to come out in 2002, as a major expansion of the formal recognition of roles for psychologists.
After several years of advocacy by APA's Practice Directorate, the American Medical Association committee in charge of CPT codes recently voted in favor of an APA proposal to institute codes that reflect psychosocial services to patients with physical health diagnoses, rather than just mental health diagnoses, as has been the case until now.
Antonio Puente, PhD, who is APA's representative to the CPT committee, says, "It's almost a paradigm shift" in terms of confirming the function of psychosocial services in physical health care.
Robert Glueckauf, PhD, another APA member who has worked on the codes, says, "The acceptance of the new Health and Behavior CPT codes by AMA is a positive development toward eliminating the mind-body dualism that has undermined our health-care system for decades."
Publication of the codes, in addition to being formal recognition of a service, is the first step to having health-care payers reimburse specifically for those codes. The next step involves gathering survey data from APA members and other professionals. These data are used to determine the value of the professional work involved in performing these services. This "work value" is used as an integral part of the reimbursement formula.
Under the CPT committee plan, a configuration of six new codes will be published for the first time in the 2002 CPT manual: two codes for health and behavior assessment services and four for health and behavior intervention services. The codes are not available for use before 2002.
For services designated by these codes, "Treatment will be geared toward the improvement of a patient's well-being utilizing cognitive, behavioral, social, and/or psychophysiological procedures designed to ameliorate disease-related problems. Thus, the focus of all these services is not on mental health, but on the biopsychosocial factors important to physical health problems and treatments," as APA's proposal for the codes indicated.
The proposal also noted that seven of the nine leading causes of death are due to unhealthy or risky behaviors and that about half of patients don't follow the regimen prescribed by their physician.
Much of the work in pushing for the codes came from a coalition of APA divisions that has worked with the Practice Directorate since 1997. The Interdivisional Healthcare Committee (IHC) represents those APA divisions whose members work most closely with physical health services delivery, including representatives from APA divisions 22 (Rehabilitation), 38 (Health), 40 (Clinical Neuropsychology), 54 (Pediatric) and most recently 17 (Counseling). As part of its mission to help expand psychology's role throughout the health services delivery system, the IHC collaborated with the Practice Directorate to develop APA's proposal to the AMA for the new non-mental health codes.
"We turned to the experts within psychology whose services in the broader health-care system were not being captured by the CPT coding system," says Randy Phelps, PhD, administrative director of the Practice Directorate. "The AMA's recent approval of the six new codes for 2002 is a major step in the right direction and the culmination of a partnership among the IHC, Dr. Puente and our staff," Phelps adds.
Glueckauf, chair of the IHC, says the acceptance of the new codes is a significant step toward ending the limitations that have been applied to "a variety of effective psychological modalities, such as interventions for enhancing adherence to treatment, coping skills training and neurobehavioral assessments."
Other professionals such as nurses, social workers and physical therapists will also be able to use the codes.
In an earlier request, APA had gained codes for neuropsychological assessment of patients who have what are considered physical disorders such as Alzheimer's disease, stroke or head injury. But the new codes recognize much broader areas of practice because they include intervention and they can be used for work with a host of physical conditions, says Laurie Badanes Prather, APA's federal regulatory affairs officer.
She also notes that the new codes recognize psychology's function outside traditional mental health bounds in other ways. Like the current psychological and neuropsychological assessment services (96100-96117), the new codes will be in a section of the CPT manual other than the psychiatry section.