November 2012 APA Assembly Report
By Robert Feder, M.D.
New Hampshire Assembly Rep
I. Finances
Operations for the APA in 2012 are even for the year, with decreases in revenue from publishing and meetings roughly equivalent to decreases in personnel expenditures. It is expected that publishing revenues will rise significantly in 2013 with the publication of DSM 5, and that meeting revenue for 2013 will also increase with the Annual Meeting being held in San Francisco. Reserves are up roughly parallel to the increases in the stock market for the year. Membership dues revenue is stable, but the number of dues paying members has decreased.
II. DSM 5
David Kupfer, M.D. reported on the status of DSM 5. DSM 5 is on track to be released at the APA Annual Meeting in May 2013. Notable changes from DSM IV are:
-Multi-axial diagnosis and the GAF scale are gone
-There is an attempt to integrate cross-cutting symptomatic descriptions and reduce the use of NOS diagnoses. An example of this is Autism Spectrum Disorder will replace Autistic Disorder, Aspergers, and PDD.
-Diagnoses will be more amenable to updates with neuroscience developments (e.g. DSM 5.1 may come out in a few years, rather than waiting a decade for DSM VI)
-Bipolar Disorder with Mixed Features – no longer need to meet full criteria for both depression and mania
-Major Depression – bereavement exclusion has been eliminated; new anxiety modifier has been added
-Disruptive Mood Dysregulation Disorder – New diagnosis, should decrease use of pediatric Bipolar Disorder
-Pre-Menstrual Dysphoric Disorder – new DX
-Binge Eating Disorder – new DX
-Hording Disorder – new DX
-Significant changes in PTSD and somatization disorder criteria
-Substance Use Disorder (mild, moderate, severe) replaces Abuse and Dependency
-All current personality disorders will remain intact, but a new trait-based method of assessing other personality disorders is included in a new section
III. New CPT Codes
Ronald Burd, M.D. presented information regarding the new CPT codes that will go into effect on January 1, 2013. Medicare and Medicaid will definitely be online with these on 1/1/2013; it is unclear how soon private insurance will adopt them, although the major companies are saying they will be ready on 1/1/2013.
-90862 will no longer be used. In its place, E and M codes (99xxx) that vary depending on level of complexity will be used. This should generally increase compensation for providers.
-A new Initial Evaluation Code with medical services (90792) should generally be used rather than 90801.
-Psychotherapy can be coded as an add-on to E and M services
- 90833 – Add on 30 minutes (16-37 minutes)
- 90836 – Add on 45 minutes (38-52 minutes)
- 90839 – Add on 60 minutes (53-67 minutes)
-Documentation requirements for the new codes will probably not be
enforced for another year
-It is recommended that you purchase the new CPT coding book from
-Questions regarding coding can be addressed to APA staff at
1-800-343-4671, or
IV. Action Papers
The following action paper items were passed by the Assembly. They all must still be passed by the Board of Trustees (no sure thing) before they become official APA actions or policy.
-A position statement revising the previous APA position statement on opiate use in terminally ill patients. The previous statement indicated patient comfort should outweigh all other concerns; the new statement calls for a more complex, thoughtful approach weighing the potential for medication diversion and dependence in patients who are now living longer.
-Initiation of a study of managed care provider networks who do not maintain adequate levels of mental health providers and coordinating with other agencies (e.g. AMA) to provide solutions
-My action paper which calls upon the APA to adopt the following Position Statement on Prior Authorization for Psychotropic Medication:
“The process of requiring prior authorization for payment of psychotropic medication by third party insurance plans is detrimental to patients. This process often results in delays for patients in receiving life-sustaining medications, and always results in psychiatrists using large mounts of time that could be better spent in treating patients. There is no clear evidence that this process improves quality of care or saves patients money. The prior authorization process is also demeaning to psychiatrists, implying that a less-trained individual who has never seen the patient can make a better treatment decision that the treating psychiatrist. The APA is therefore opposed to any requirement of prior authorization for psychotropic medications prior to payment by insurers except for instances of clear outlier practice or concern for patient safety. Such instances requiring prior authorization or supportive information should be made only by an identifiable Board Certified Psychiatrist.”
-An Action Paper I was co-author on calls for the APA to include in its Practice
Guidelines recommendations that psychiatrists discuss with all female patients of child- bearing age the following: pregnancy plans, contraception options, and medication interactions with contraception. If a psychiatrist is not comfortable with this due to personal beliefs, the patient should be referred to another professional willing to have the discussion.
-That the APA hire an educational consultant to help assess whether the
procedures promulgated in the American Board of Psychiatry and Neurology’s(ABPN) new maintenance of certification program meet appropriate education standards and are relevant to the practice of psychiatry
-That the APA lobby the ABPN to designate lifetime diplomats as “Lifetime
Certified, not participating in MOC and not required to do so” rather than “Certified but Not Meeting MOC Requirements”
-That the APA certify CME activities provided by District Branches with no
charge to the District Branch
-That the APA petition the FDA to inform managed care organizations that they should cease using wording that implies that insurance entities’ refusal to provide coverage for medications based on diagnosis or dosage is supported or endorsed by the FDA.
-Approval of a recommendation from the APA Ethics committee to change the language of Section 8 of the Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry which deals with potential conflicts of interest in organizational settings. The new wording is simpler and less restrictive than the wording currently found in Addendum 1.