Is the Mental Health Coding Debacle a Portent of ICD-10?

When the American Medical Association updated some 30 Current Procedural Terminology (CPT) codes for mental health services, the result has been “chaos,” according to Randy Phelps, deputy executive director for the American Psychological Association, in an interview with NBC News.

The new codes went into effect on Jan. 1, and many providers and payers were unprepared. Some mental health professionals have not had claims reimbursed since the new codes took effect, either because they had used the codes incorrectly or payers’ systems were unable to process the new codes. Does this bode ill for the upcoming migration to ICD-10, which changes thousands of codes?

With ICD-10, the entire healthcare supply chain has had plenty of warning, including one major extension to the implementation. The change in behavioral health CPT codes was published in November and implemented Jan. 1. Mental health professionals in essence were required to change the coding procedures they had been using for 15 years almost overnight. ICD-10 has been well publicized, and providers still have more than 18 months to make the migration.

But from the mental health coding debacle, there are lessons to be learned that should make every provider switching to ICD-10 sit up and take notice:

You might be prepared, but your partners may not. Hospitals and other heavily trafficked inpatient providers will be well prepared for ICD-10, but what about third-parties — specialized laboratories, small payors, and other groups. Much of the “chaos” from the mental health CPT code change came from payers and from small billing companies. ICD-10 implementation will only be as good as the weakest link in the chain.

Don’t underestimate the need for communication and training. Thirty codes, what could happen? If staff is under-trained on how to use the codes or the code change is poorly communicated, the result can be disaster.

Don’t wait until the last minute. Providers and payers had two months to prepare for the changes in the mental health CPT codes, and it clearly was not enough; ICD-10 changes thousands of codes. If you haven’t started your ICD-10 project, you’re probably already too late.