Billing / Billing Codes

The International Classification of Diseases–9th Edition–Clinical Modification (ICD–9–CM) is a diagnosis classification system used to identify diseases. In 2003, the Health Insurance Portability and Accountability Act (HIPAA, P.L. 104–191) standardized uniform electronic code sets and identified ICD–9–CM, or its updated counterpart, as the diagnostic code set to use when seeking reimbursement for services performed. The ICD–9–CM is over 30 years old, contains outdated and obsolete terminology, and does not accurately describe diagnoses of the 21st century. Therefore, it will be replaced in 2013 by the International Classification of Diseases–10th Edition–Clinical Modification (ICD–10–CM).

Effective January 2013, clinical social workers will begin using new and revised psychotherapy codes when providing psychotherapy services to patients. For the first time since 1998, the family of psychotherapy codes has gone through a major revision process. NASW provided national social work leadership in the development and approval processes for the new and revised psychotherapy codes through the American Medical Association Current Procedural Terminology (CPT) Editorial Panel. In addition to working with CPT panel, NASW also worked collaboratively with the American Psychiatric Association, Academy of Child and Adolescent Psychiatry, American Nurses Association, and American Psychological Association.

Clinical social workers should prepare for three major practice changes which will significantly impact the way in which clinical social workers practice and seek reimbursement for mental health services they perform. 

Purpose of Survey: To obtain estimates of time and complexity required in performing a psychotherapy service; to obtain estimate of a recommended professional work value; and, to determine the rate at which Medicare and other third-party payers reimburse for psychotherapy services.

The Humanistic Psychology Society, Division 32 of the American Psychological Association, has prepared a sign-on letter to the DSM-5 Task Force that seeks support from mental health professionals and organizations.

The psychoanalysis Current Procedural Terminology (CPT) Code is being considered for review to increase the work and practice expense values associated with reimbursement rates. Work values are based on the time and the required mental effort and judgment to perform a service, and the stress encountered due to the potential risk to the patient.