Revised NYSPA Documentation Template

OPTUM Issues Provider Alert Addressing Documentation of Psychotherapy Combination Codes

United Behavioral Health (Optum) has issued a Provider Alert addressing documentation of the new psychotherapy combination codes (E/M plus Psychotherapy Add-on Code). You can read the Provider Alert by clicking here.

The Provider Alert reflects extensive feedback and suggestions from both the APA and NYSPA. The NYSPA template for psychotherapy combination codes, currently available in the CPT coding section of the NYSPA website (, includes all the clinical information required in the Optum Provider Alert. The only change is the addition of the requirement to document time spent providing psychotherapy. We have learned now that when CPT first developed the new combination codes, it was CPT’s intention that the time spent providing psychotherapy alone be documented. Therefore, we have modified our combination code template on the NYSPA website to replace “Start and Stop Time” with “Approximate Psychotherapy Time”. For 90833, the minimum psychotherapy time is 16 minutes and for 90836, the minimum psychotherapy time is 38 minutes.

We have elected to retain documentation of total face-to-face time (although not mandatory) to establish that there was sufficient total time to provide both an E/M service and a psychotherapy add-on service.

Optum has advised NYSPA that this new requirement will be enforced prospectively only. We also anticipate that Medicare will issue a similar advisory requiring documentation of psychotherapy time as well. NYSPA will be scheduling a webinar on the new documentation template shortly.

Psychiatry Embraces Patient-Centered Care

Lisa Dixon, M.D., M.P.H.; Jeffrey Lieberman, M.D.

From the President

January 29, 2014 DOI: 10.1176/

Lisa Dixon, M.D., M.P.H.; Jeffrey Lieberman, M.D.

Psychiatry has long been considered the medical specialty most attuned to listening to the patient. With few diagnostic laboratory or imaging tests available or other physical indicators of illness, psychiatrists have been trained to attend carefully to their patients’ histories and subjective reports of symptoms to make a diagnosis and determine the course of treatment. But the nature of the doctor-patient relationship was traditionally one-sided. Patients talked and their physicians listened, and then the doctor prescribed the treatment and the patient followed.

But now psychiatry is changing as the field of medicine adopts patient-centered care. This model of care places greater emphasis on the patient’s involvement in determining the goals of treatment that are meaningful to them and the nature of their care. Meaningful goals for patients generally go beyond symptoms to include quality of life, functioning, and a sense of hope and self-efficacy. Patient-centered care isn’t just about putting the patient at the center of the care equation. Rather, it shifts the balance of authority and responsibility of the doctor-patient relationship and incorporates shared decision making (SDM) between the clinician and the patient, particularly when it comes to treatment. SDM is defined as “a collaborative process that allows patients and their providers to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values and preferences.” Practicing SDM requires that psychiatrists assess the patient’s interest in participating in decisions, providing information to them on the risks and benefits of specific treatments or approaches in an understandable format, and dialogue with patients about their choices. SDM does not mean that psychiatrists don’t make strong recommendations; rather, it means that those recommendations need to be reconciled with patients’ views and choices.

The promise of this change is that, with patients taking a more involved role in their treatment decisions, physicians will better understand their patients’ needs and concerns and be better able to offer an informed course of treatment. It also brings the hope that patients will be more inclined to adhere to treatment and share important information about their response (including side effects), thereby enabling their physician to make adjustments as needed. This is not an insignificant change. In psychiatry, as in all of medicine, patient adherence is a prevalent problem and major limitation of treatment. For numerous reasons, many patients are unable or unwilling to follow through on “doctor’s orders,” with worsening symptoms as a consequence. In this context, doctors may discover that their orders may cause problems that the patient has not previously been willing to reveal.

There are other benefits to patient-centered care. Shared decision making between psychiatrist and patient can improve the efficiency and productiveness of patient visits, both indicators of quality care and precursors to improved patient mental health.

This new paradigm is not without its challenges. Empowering patients to be active participants in their care often requires educating them about their disorder and options for therapy to ensure they are prepared to ask relevant questions and understand the answers. Certainly this process is more difficult for patients whose disorders impair their cognitive and decision-making abilities. In fact, these concerns are cited by some psychiatrists as the reasons they are reluctant to embrace this care model. However, it is our job to develop the means to facilitate this mode of communication with patients and their participation in care. Initially, clinicians may find this role difficult because of the increased time and effort it requires and uncertainty on how best to teach and motivate patients in this way.

There are several innovative efforts seeking to address these concerns by providing new direction on how to educate patients and increase their engagement in care. One study utilized group training on shared decision making among people with schizophrenia, comparing it with a control group that did not receive the training. Those patients engaged in the decision-making instruction were more involved in their own care, and more likely to continue to take their medications. CommonGround, a web-based application that facilitates shared decision making among individuals with mental illness, received APA’s 2013 Psychiatric Services Gold Achievement Award. Electronic tools have great potential in facilitating communication and shared decision making.

Family engagement that is contingent on the patient’s agreement and invitation can also be an important part of patient-centered care. Many prior efforts to implement family-based services for adults with mental illness have had a disappointing response, perhaps because there has been too little focus on the patient’s preferences. New models of family engagement are seeking to improve this component of treatment. A pilot program implemented within the Veterans Affairs system in Maryland and in California encouraged family participation contingent upon the interest and invitation of the patient. This program served to elicit significant and sustained engagement by both families and patients.

Psychiatry has always been the field of medicine that prided itself on emphasizing the doctor-patient relationship. We now need to extend this practice, to enhance patient involvement, and begin listening—and talking—to our patients in new ways. To do so will only enhance the physician-patient relationship and the quality of health care.

Posted in APA

Nominations Being Accepted for Area II Resident-Fellow Member Deputy Representative to the APA

Nominations now being accepted for the position of:


Interested Candidates Must Submit:

* A letter of interest

* A Curriculum Vitae

* A letter of support from your Residency Training Director/Chair
indicating you will have time to serve

* Two letters from members of your local District Branch

Additional information is posted below.

See your Residency Training Director for more information


1. Represents Area II RFMs (New York State) in the Assembly of District Branches of the American Psychiatric Association (APA).

2. Represents interests of RFMs in the Assembly and the Area II Council.

3. Informs the Assembly and the New York State Psychiatric Association of issues of significance to RFMs.

4. Attends Assembly meetings in November and May.

5. Attends Area II Council meetings.

6. May serve on components (Task Force & Committees) of the Assembly and the New York State Psychiatric Association.

7. Is elected for a two year term with succession to RFM Representative in the second year. The two year term begins immediately after the APA Annual Meeting. In the second year, the RFM Deputy Representative succeeds to the position of RFM Representative.

8. Is available for at least six weekdays per year to fulfill these responsibilities.

9. Organizes and attends Area II RFM meetings.

Eligibility Criteria:

1. Candidates must have at least two years of training (including post residency fellowship) in Area II remaining at the time of election.

2. At the time of recommendation for nomination, a candidate must be either a Member in Training of the APA or have submitted an application. The successful candidate must be a Resident-Fellow Member when the term of office begins.

3. Candidates must submit Curriculum Vitae, a statement of interest and intent to fill the two year term of office and two letters of recommendation from local district branch members. The training director’s letter may count as one letter provided the director is a member of the local district branch.

4. Residency training directors or department chairpersons must write a letter stating that, if elected, the RFM will be excused from clinical responsibilities for at least six (6) weekdays per year and be allowed to honor this two year commitment as part of training.


Residents who wish to be recommended for nomination may recommend themselves or be recommended by a local district branch member, their training director or a residents’ group.

The following material must be submitted in the applications:

1. A statement of interest from the resident that includes a statement of intent to serve the two year term.

2. A letter of support from the training director or chair stating that the resident, if elected, will be allowed to honor this two year commitment as part of training and that the resident has at least two years remaining in training. (For the residents who are accepted into a fellowship, this letter is to come from the director of the fellowship.)

3. Letters of recommendation from two district branch members. (The training director’s letter may count as one letter provided the director is a member of the local district branch.)

Please send all material to:

Donna Gajda
New York State Psychiatric Association, Inc.
400 Garden City Plaza, Suite 202
Garden City, New York 11530

All material must be received by February 3, 2014
If you have any questions, please call:

Kendra Campbell, M.D.
RFM Representative to the Assembly 2013-2014

Kandace McAlister Licciardi, M.D.
RFM Deputy Representative to the Assembly 2013-2014

APF Seeks Applications for Advancing Minority Mental Health Awards

The American Psychiatric Foundation is accepting applications for its 2014 awards for advancing minority mental health. This annual award recognizes mental health professionals, programs, and organizations that have undertaken innovative efforts to raise awareness of mental illness in underserved minority communities, increase access to mental health care for underserved minorities, and/or improve the quality of care for underserved minorities. Application deadline is February 12.

Posted in APA

APA Announces Medicare Reimbursement Victory on Psychiatry Work Values

The federal Centers for Medicare and Medicaid Services has accepted work values for a number of psychiatric codes (90791/92 and the 908XX codes) that will result in increased Medicare payment for psychiatrists using those codes. The work values, which are recommended by the AMA’s Relative Value Update Committee, are part of a complex payment formula that includes practice expense and other variables to derive a fee for every code used by physicians. Go here to learn more!

Posted in APA

National Health Service Corps (NHSC) Loan Repayment Program accepting applications

The NHSC program supports qualified health care providers, including psychiatrists, in exchange for two-years of service in specific Health Professional Shortage Areas. The NHSC program is currently accepting applications for FY2014 Loan Repayment Program awards. This program is open to licensed primary care medical, dental, and mental and behavioral health providers who are employed or are seeking employment at approved sites.

Integrated Care and Psychiatry

In the changing health care environment, one clear trend is greater integration of primary care and behavioral health care. APA has compiled extensive resources to help psychiatrists understand and stay abreast of the issues. Go here to see the latest research, news, analysis, policy, collaborative care models, and more, including short videos from leaders in the field and a Toolkit of practice resources.

APA Announces Medicare Reimbursement Victory on Psychiatry Work Values

The federal Centers for Medicare and Medicaid Services has accepted work values for a number of psychiatric codes (90791/92 and the 908XX codes) that will result in increased Medicare payment for psychiatrists using those codes. The work values, which are recommended by the AMA’s Relative Value Update Committee, are part of a complex payment formula that includes practice expense and other variables to derive a fee for every code used by physicians. Go here to learn more!

Posted in APA

Call for Applications: APA Medical Student Senior Elective in HIV Psychiatry

The American Psychiatric Association established the Medical Student Senior Elective in HIV Psychiatry in 2004 to provide an opportunity for 4th year minority medical students to participate in a one-month clinical or research elective in HIV psychiatry.

With improvements in HIV drug therapy there is a burgeoning demand to treat the mental health needs of those living longer with the disease. People with HIV have a higher incidence of mental health problems than the general population and people with serious mental illness are more at risk for contracting HIV. HIV attacks the brain, causing inflammation and tissue deterioration. Infection of the brain also can lead to clinical depression, mild or moderate thinking problems, and trouble with memory and focus. Unfortunately, the mental health needs of people living with HIV/AIDS are too often overlooked.

Undoubtedly, future physicians need to develop a working knowledge of HIV-related psychiatric and neuropsychiatric issues. The purpose of the Medical Student Elective in HIV Psychiatry is to foster the participation of racial and ethnic minority medical students in HIV-related care and research and provide them with a means of obtaining essential HIV-related mental health training through an integrated approach to patient care.

Description of the Project
This September the Elective in HIV Psychiatry begins with intensive two-day training in Washington, DC. Topics range from neuropsychiatric complications of HIV, somatic complaints, and mood disorders to special patient populations including people with substance use disorders and/or those suffering from severe mental illnesses. Training modalities include a combination of lectures, role playing, case vignettes, and first-person accounts through interviews with HIV positive people. Students then travel to training sites for their clinical or research experience for the month of September.

To date, seventy-one students have completed the full month-long elective. Prior sites have included: Cambridge Health Alliance/Zinberg Clinic; The New York Presbyterian Hospital at Columbia University; The New York-Presbyterian Hospital Cornell University Center for Special Studies (CSS); Emory University/Grady Infectious Disease Program; Howard University; University of Pittsburgh Medical Center; University of Cincinnati; University of Miami, Stanford University, Beth Israel Medical Center, Vanderbilt University, and the University of South Florida (for a research elective in HIV Neuroimmunology in Psychiatry.) Tentative dates for the elective are August 23 to September 20.

The application deadline is March 31, 2014 with selections to be announced in late April. Apply Now

Posted in APA

NYSPA Prescribing Update


Prescribing Update

NYS Medicaid has announced that practitioners must now be enrolled in Medicaid to enable them to continue to prescribe medication for Medicaid beneficiaries (dual eligible patients may also be affected).

Pharmacies will be unable to fill prescriptions written for Medicaid beneficiaries if the prescriber is not enrolled in NYS Medicaid FFS (fee for service). This applies to both new prescriptions and refills.

The enrollment requirement applies to all services, including prescription drugs, provided under the Medicaid state plan or under a waiver of the state plan (the Fee For Service Medicaid program). It does not apply to services paid through a Medicaid managed care plan.

Effective January 1, 2014, FFS Medicaid will implement new FFS claims editing requiring Medicaid FFS enrollment for ordering/prescribing/referring/attending (OPRA) physicians and other healthcare professionals. If the ordering professional is not enrolled, under federal law Medicaid must deny the claim for the ordered service.

Ordering professionals who have not yet submitted enrollment applications must do so immediately to avoid future interruption of the services they order for their patients.

OPRA professionals who submit an application between January 1, 2014 and March 31, 2014 will be given an enrollment effective date of January 1, 2014.

Enrolling as an Ordering/Prescribing/Referring/Attending Provider

If you are not currently enrolled in the Medicaid program, you can enroll as an Ordering/Prescribing/Referring/Attending (OPRA) provider by following the instructions on the eMedNY website at

Verification of Provider Enrollment

If you are unsure whether you are currently enrolled as a Medicaid provider, you can easily verify your enrollment status on the eMedNY website at

Additional information regarding enrollment as an OPRA provider can be found at:

For more updated FAQs on OPRA requirements, background, enrollment and claims editing, please visit the provider enrollment website.

NYS Justice Center Seeks Nominees for New Medical Review Board


NYSPA has been notified that the NYS Justice Center for the Protection of People with Special Needs is seeking potential candidates for its Medical Review Board. The NYS Justice Center, which began operations on June 30, 2013, was established to provide advocacy and incident investigation on behalf of individuals with special needs who receive services from a variety of state agencies and programs. The Justice Center operates a 24/7 hotline to report abuse, neglect and significant incidents and also maintains a staff exclusion list.

The formation of a new Medical Review Board is priority for the Justice Center. This core group of medical professionals will provide assistance in reviewing cases and formulating the policy and procedures necessary to ensure that New York State’s most vulnerable citizens are protected. The voluntary Medical Review Board is to be comprised of up to fifteen members who will be charged with the review of the circumstances surrounding the deaths and allegations of abuse or neglect reported to the Justice Center. The law requires inclusion of medical specialists in forensic pathology, psychiatry, internal medicine and addiction medicine. In addition to those specialists required by law, they are also interested in physicians with experience treating people with developmental disabilities and/or specialists in orthopedics, pediatrics, child psychiatry, cardiology, gastroenterology, radiology, and anesthesiology.

Please contact NYSPA Central Office no later than January 15, 2014, if you are interested or know anyone who might be interested in being nominated to the Medical Review Board. Please forward the nominee’s contact information and curriculum vitae to or via facsimile to 516-873-2010, Attn: Donna Gajda. Please note that under our current agreement with MSSNY, any psychiatrist nominee for a state board position will be proposed by both MSSNY and NYSPA and therefore, nominees must be members of both NYSPA and MSSNY at the time of their nomination.

Psychologists to Pursue Prescribing Authority in New York


We are taking this opportunity to communicate directly to our members about an issue of critical importance. Organized psychology has indicated its intent to pursue prescribing authority for psychologists in New York State in the coming legislative session by introducing a bill that would permit psychologists, by securing a master’s degree in psychopharmacology, to prescribe a limited formulary of medications. Needless to say, NYSPA will marshal all its resources to defeat any attempt to permit psychologists to prescribe medication.

As a result of NYSPA and MSSNY efforts in the past, New York is currently the only state in the nation with a law specifically prohibiting psychologists from prescribing medication. In 2002, psychology sought passage of legislation that would establish its scope of practice under relevant sections of the Education Law. At that time, NYSPA and MSSNY both agreed not to oppose such legislation if, and only if, it included a specific statutory prohibition on psychology prescribing. Therefore, as agreed to by all interested parties, the psychology scope of practice statute stated that psychologists ” . . . shall be prohibited from . . . prescribing or administering drugs as defined in this chapter as a treatment, therapy or professional service in the practice of his or her profession . . .”

Now, psychology apparently intends to renege on its 2002 agreement by seeking to remove the statutory prohibition on prescribing and create a new pathway for psychology prescribing. If a psychology prescribing bill is introduced in the upcoming legislative session, we will need all members to take action – writing to their state legislators, contacting media, educating the public, working with our physician colleagues and supporting our PAC to beat back this assault on the scope of practice of medicine.

We will keep you advised of developments as they occur and look for your support and assistance.

Glenn Martin, M.D., President NYSPA
Seeth Vivek, M.D., Vice President NYSPA
Richard Altesman, M.D., Secretary NYSPA
Jeffrey Borenstein, M.D., Treasurer NYSPA
James Nininger, M.D., Area II Trustee
Deborah Cross, M.D., Past President NYSPA
Barry B. Perlman, M.D., Chair, NYSPA Legislative Committee