Practice Alert
September 2012

Mirean Coleman, LICSW, CT
Senior Practice Associate

Major Changes in 2013 For Clinical Social Workers

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.   Occurring in 2013, the changes are in the areas of coding, diagnosing, and measurement and include the following:

  • The psychiatric Current Procedural Terminology (CPT) codes are expected to change January 1, 2013.  Clinical social workers use CPT codes to identify services/procedures performed when seeking reimbursement.  Changes will include replacement of the current outpatient individual, interactive, and residential care CPT psychotherapy codes.   As information is disseminated about the new codes, NASW will inform its members of the new codes, and develop training and technical assistance to assist its members in adapting to the new coding changes.
  • The Centers for Medicare and Medicaid Services (CMS) has announced the Physician Quality Reporting System (PQRS) will subject clinical social workers and other health care professionals who are Medicare providers to a 1.5 percent penalty fee in 2015 if they do not use measures when performing services to Medicare patients during the year of 2013.  PQRS is a program promoting the reporting of measures to determine quality services. To avoid this penalty in 2015, clinical social workers must begin using clinical measures developed by PQRS in 2013.  A list of measures and instructions on how to use measures with Medicare patients is available online at the PQRS Web site at the following link:  http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html?redirect=/pqrs  
  • The fifth edition of the Diagnostic Statistical Manual of Mental Health Disorders (DSM-5) is expected to be released in May 2013.  The DSM is a classification of mental health disorders commonly used by clinical social workers when conducting a diagnostic assessment. Clinical social workers may find changes which include new, deleted, or expanded diagnostic criteria and coding for mental health diagnoses.  NASW will provide additional information about the DSM-5 as it becomes available and assist members in transitioning to the DSM-5 through trainings and technical assistance.

The 2013 transition from the International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9th-CM) to the International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10th-CM), has been delayed until October 2014 to allow the health care industry additional time to prepare for it.  The ICD is a set of codes used to identify and report medical diagnoses. Clinical social workers should also begin preparing for this major change. 
Preparation
Preparation for coding, diagnosing, and measurement changes include the following:

  • Updating electronic systems, billing statements, and other forms
  • Communicating with third-party payers about their specific requirements regarding these changes
  • Enrolling in training to become familiar with the new changes and how to implement them in practice.

NASW has provided advocacy for its members in the development of changes in CPT psychiatric coding, measure development for clinical social workers in the PQRS and DSM-5.  As stated above, NASW will be available to provide technical assistance to members as these changes are implemented.

Additional information about the 2013 changes is available online at the DSM-5 Web site:  http://www.dsm5.org/Pages/Default.aspx, and the American Medical Association Web site at:  http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/cpt-changes-workshops.page.  Information about the 2014 transition to the ICD-10-CM is available online at http://www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/ICD10/     

 


http://www.socialworkers.org/practice/clinical/2012/092012.asp
10/31/2014
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