CPT Coding for Mental Illness Diagnoses

Sir: The recent article¹ in the Companion on billing for psychiatric services in primary care appropriately describes the fact that most payers will not reimburse primary care physicians for 908xx Current Procedural Terminology (CPT) codes. In addition to this restriction, my experience is that many commercial payers (especially those with “carve-out” plans for mental health services) will not reimburse a primary care physician for a traditional evaluation and management (E&M) CPT code if the primary ICD-9 diagnosis is within the domain of mental health.

For example, a primary care physician coding 99234 with an ICD-9 diagnosis of 309.0 (adjustment disorder with depressed mood) may not be paid, while a physician who submits 99234 with a primary ICD-9 diagnosis of 780.7 (malaise and fatigue) and a secondary ICD-9 diagnosis of 309.0 would be appropriately compensated.

While this strategy could be construed as “gaming the system” by reporting a physical diagnosis or symptom as the primary problem, I have found that it is an appropriate and necessary method of assuring adequate compensation for the valuable services we provide to our patients.