In 2007, I wrote a post called "Why Shrinks Don't Take Insurance."  The post is a bit dated, the CPT codes have changed since then, and the reasons to not take insurance have increased.  Many other doctors don't take insurance now, though psychiatry remains the number one specialty where doctors don't participate in health insurance plans.  This is an updated version of that same post. Many psychiatrists in private practice don't ...

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First a disclaimer: I’m a psychiatrist, not a cardiologist, but I’ve followed with personal interest the discussions about calculating cardiac risk and indications for statin treatment.  Risk is an interesting word, because risk is about populations; it loses the individual. And it seems that statin treatment has taken on a bit of stigma -- something we’re used to in psychiatry -- now you can eat your cake and have low cholesterol, ...

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I’m lucky, I work for one of the best hospitals in the country and I have access to the best medical care that our society has to offer. With one glitch, that is -- when I access that care, my medical records are put into a system that can be viewed by thousands of people, some of whom include my bosses, co-workers, supervisees, neighbors, and even some of my patients. I ...

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For the first 20 years of practice, assigning a code to the services I offer has been easy. I see most patients for “90807” – a 50 minute psychotherapy session with medication management.  It all gets mushed together, a patient may talk about an upsetting event in their lives (psychotherapy) and then mention they are having trouble sleeping or a side effect to a medication (medication management), then go on ...

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Going to the doctor can be confusing.  Doctors make recommendations based on what they know, and patients are conditioned to trust their doctors.  While I think it's wonderful that patients trust their doctors, there are times when patients want more input into their health care, and if this is the case, then let me make some suggestions as to what might be important questions to ask.  There is nothing specific ...

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Sam is young man is applying for a summer program, a real resume builder.  Among other things, the application asks if he has been treated for a psychiatric disorder.  In fact, he's seen a therapist and he's felt anxious at times.  His internist gave him some Lexapro samples and he feels better.  The symptoms of his problems have been limited to his own subjective distress.  His anxiety is not something ...

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Angry Birds: A psychiatrist explains the addicitionJoe Frisch is a staff scientist at the SLAC National Accelerator Laboratory at Stanford University. Dr. Frisch writes: "I wonder when we will start seeing really addictive games banned? I don't know what makes games addictive though. Angry birds is a mystery to me - there is no ongoing story line, you don't really gain any abilities as the game ...

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For years, I supervised residents. They would come in each week and tell me about a patient in crisis. If no one was in crisis, they’d say all their patients were fine and they didn’t know what to talk about, even though I had told them to pick a patient they saw weekly and either audio-record the sessions or take detailed process notes. Psychotherapy, I would say, is a ...

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Perhaps you've heard the news: psychiatrists no longer have time to listen to their patients.  It's all about writing prescriptions for medications and the days of "tell me about your mother"  are long gone, or so we're told.  The current perception is that large volume practices where patients are seen in a matter of minutes are now standard and acceptable in psychiatry; that it's how many -- if not ...

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We really don't even have a precise definition of what "psychotherapy" is, and CPT coding has defined it in terms of time spent in a session and reimbursements. A 50-minute session gets coded as 90807 which stands for "45-50 minute psychotherapy session with medication management on an outpatient basis in a physician's office."   The frequency doesn't matter, nor does the content of what transpires-- at least not for the CPT ...

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