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Dr. Pies, psychiatrists bill for non-existent psychotherapy


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Dr. Ronald Pies is ubiquitous on mental health blogs, usually expressing, in the voice of someone both intelligent and reasonable, a defense of psychiatry as it is practiced today. Dr. Pies, a psychopharmacologist, developed the Bipolar spectrum diagnostic scale (BSDS) and is an expert on "treatment-resistant depression," which seems to emerge after a person has been treated with multiple psychiatric drugs.


(Researchers are starting to ask questions about whether "treatment-resistant depression," which is increasing in frequency, might not be an iatrogenic consequence of psychopharmacology; see http://survivingantidepressants.org/index.php?/topic/343-about-treatment-resistant-depression-and-poop-out/ )


In an April 2011 article on Psych Central, Dr. Pies defends psychiatry again, in Has Psychiatry Really Abandoned Psychotherapy? Behind the New York Times Story


He is addressing a March 6 New York Times article that has caused quite the kerfuffle in psychiatry: Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy


Dr. Pies sums up the NY Times article: "A fifteen-minute med check, a ‘scrip for some Prozac, and you’re outta here, buddy!


"You got other problems? Talk to your therapist!"


The NY Times article does imply that psychiatric "treatment" is cursory and focused on producing a prescription.


Dr. Pies asks "....But how accurate was the Times’ portrait of outpatient psychiatry?


"....I’m sorry to say that this story was a disservice both to the Times readership, and to the profession of psychiatry. Although the article may have been a well-intended expose of malign insurance company practices, it amounted to a jaundiced caricature of psychiatric care — accurate in some respects, but distorted in many others. Furthermore, by disparaging the role of psychiatric medications, the Times article reinforced the “mind-body” split that has bedeviled psychiatry for the past 50 years, as Tanya Luhrmann showed in her classic study, Of Two Minds: The Growing Disorder in American Psychiatry.....


....Let’s also acknowledge that the general trend reported by the Times — the diminishing use of psychotherapy by psychiatrists — is quite real. Over the past decade or so, the percentage of psychiatrists offering psychotherapy to all or most of their patients appears to have dropped. One study — very selectively cited in the Times article — found that “just 11 percent of psychiatrists provide talk therapy to all patients…”1 This was based on a study by Mojtabai and Olfson, which found a decline in the number of psychiatrists who provided psychotherapy to all of their patients — from 19.1% in 1996-1997 to 10.8% in 2004-2005. The study also found that the percentage of visits involving psychotherapy declined from 44.4% in 1996-1997 to 28.9% in 2004-2005, which “…coincided with changes in reimbursement, increases in managed care, and growth in the prescription of medications.”


"But the very same study found that almost 60% of psychiatrists were providing psychotherapy to at least some of their patients. Also, the threshold for considering a session “psychotherapy” was set quite high in the Mojtabai-Olfson study: the meeting had to last 30 minutes or longer. But as my colleague Paul Summergrad MD has pointed out, common practice and standard CPT billing codes (e.g., 90805) specifically include 20-30 minute visits for psychotherapy, with or without pharmacotherapy.....”


This last statement appears to be the statistical cornerstone of Dr. Pies's defense.


In my personal experience, every one of the half-dozen psychiatrists I’ve seen since 2001 in San Francisco has billed for the higher-paying CPT code rather than lower-paying medication management, even though he or she never spent more than a half-hour with me (more often 15 minutes), and did nothing but med management.


It’s not that so many psychiatrists provide “some” psychotherapy with their pharmaceuticals, it’s that so many psychiatrists routinely commit insurance fraud by deliberately using the wrong CPT code. Hey, they all do it — it’s a standard of the profession.


So the truth is, psychiatry has sunk even lower than the NY Times article implied.




Patients -- what's been your experience with psychiatrists and billing codes?

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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