Virtual Forum: Navigating the New E/M Framework: AACAP’s Coding Experts Answer Your Questions.

Slide Deck of the Forum (PDF)

In January of 2021, revisions to the selection criteria for the Evaluation and Management (E/M) codes went into effect. While these changes were meant to simplify clinical practice and reduce “note bloat,” many questions have arisen about how to navigate the new framework. 

During this interactive Virtual Forum, AACAP members had the opportunity to ask questions about how to apply the new code selection criteria to their own clinical practice, understand how to code for visits without the patient present, gain confidence in writing an effective note that will support the services provided, and gain a greater understanding of how the E/M codes interact with the other codes commonly used by child and adolescent psychiatrists, such as the add-on psychotherapy codes. An overview of these topics will be provided, followed by a question-and-answer period. 

Objectives

• Describe the new E/M framework
• Explain how to apply the codes to real-life situations
• Discuss documentation tips and principles for outpatient visits

Speakers

Sherry Barron-Seabrook, MD
Co-Chair - AACAP CPT Coding and Reimbursement Committee 
Associate Clinical Professor of Psychiatry - Rutgers Robert Wood Johnson Medical School

Benjamin Shain, MD, PhD
Co-Chair - AACAP CPT Coding and Reimbursement Committee
AACAP CPT Advisor to the AMA

Jason Chang, MD
Member - AACAP CPT Coding and Reimbursement Committee
Private Practice

Morgan Fallor, MD, MBA
Member - AACAP CPT Coding and Reimbursement Committee
University of Chicago

Dorothy O’Keefe, MD
Member - AACAP CPT Coding and Reimbursement Committee
Associate Professor of Psychiatry, Virginia Commonwealth University
Virginia Treatment Center for Children

Healthcare Disparities through the Lens of Diversity During the COVID-19 Pandemic

Slide Deck of All Presentations (PDF)

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”
― Rev. Martin Luther King, Jr.

Like other diseases – both chronic and infectious – the COVID-19 pandemic has brought to the surface disparities in the burden of illness that members of racial and ethnic communities face. Racial and ethnic communities not only suffer from certain diseases at larger numbers, their health outcomes or prognoses are made worse by long-standing issues such as racism, lesser access to quality care, and other social determinants like educational attainment and living wage. Physicians play an integral role in reaching the goal of equality in health care for all. As we add the COVID-19 lens to this important dialogue, we must find ways to be increasingly engaged in the fight against disparities – particularly as they relate to mental health disparities in children of color. Through the AACAP Diversity and Culture Committee and leadership from the Asian, Black, Latino, and International Medical Graduate Caucuses, this forum identifies and addresses racial and ethnic healthcare inequities and shares and explores solutions at both the provider practice-based and community level. 

Objectives

• Highlight mental health, COVID-19, and other healthcare disparities related to race and ethnicity among children and adolescents of color.
• Describe how racism and lack of access to care help to perpetuate disparities and inequities.
• Provide examples of how social determinants impact length and severity of health outcomes.
• Provide examples of systems and resources that have been successful in addressing health disparities and COVID-19.
• Provide ideas and strategies on how to best close the COVID health disparities gap.
• Provide ideas and strategies on how to best close the mental health disparities gap.

Outline of Forum

• Introduction of Forum and Speakers  
• Address from AACAP President
• Review of COVID-19 and Health Disparities 

• Each AACAP caucus will include a 10-15 minute presentation and 15-20 minutes for questions and discussion

• Access to Care and Other Social Determinants
• Bias and Racism in Clinical Service Delivery
• Positive Strategies for Addressing Health Disparities at the Practice and Research Levels 

Chairs

Cheryl Al-Mateen, MD
Professor of Psychiatry and Pediatrics, Virginia Commonwealth University

Angel Caraballo, MD
Private Practice
Immediate Past President NY Council on Child and Adolescent Psychiatry

Moderators

Gabrielle Carlson, MD
AACAP President

Melvin Oatis, MD
Private Practice
AACAP Chair, Assembly of Regional Organizations of Child and Adolescent Psychiatry

Speaker Panel

Balkozar Adam, MD
AACAP International Medical Graduate Caucus
Missouri University School of Medicine

Jang Cho, MD 
AACAP Asian Caucus
Yakima Valley Farm Workers Clinic

Lisa Cullins, MD
AACAP Black Caucus
National Institute of Mental Health Division of Intramural Research Programs 

Rebecca Susan Daily, MD  
AACAP Native American Child Committee
The Rainbolt Family Chair in Child Psychiatry
Vice Chairman of Child and Adolescent Psychiatry of the Department of Psychiatry and Behavioral Sciences at the University of Oklahoma College of Medicine 

Lisa Fortuna, MD, MPH, MDiv
AACAP Latino Caucus
Chief of Psychiatry, Zuckerberg San Francisco General Hospital
Vice-Chair of Psychiatry, University of California San Francisco

Thomas Hoffman, MD  
AACAP Rural Health Committee
Shodair Children’s Hospital

Annie S. Li, MD
AACAP Asian Caucus
Assistant Professor of Clinical Psychiatry, Division of Child and Adolescent Psychiatry, Weill Cornell Medical College 

Richard L. Livingston, MD
AACAP Native American Child Committee
Vista Health Services, Inc.

AACAP’s COVID-19 Virtual Forum: Hospital-Based Care Settings

Slide Deck of All Presentations (PDF)

This forum is sponsored by AACAP’s Physically Ill Child, Emergency Child Psychiatry, and the Inpatient and Partial Hospitalization Committees 

Over the past month, our country has faced an unprecedented health crisis with the rapid spread of COVID-19 and the resulting pandemic that has shaken our health systems to the core. We have witnessed the tremendous morbidity and mortality of this crisis and how it has caused many of our health systems to rapidly develop strategies to address the surge in COVID-19 cases. This includes mitigation of infection risk, promotion of safety among staff and patients, as well as innovation to preserve personal protective equipment, promote social distancing, and leverage telehealth, while preserving a high standard of care for patients and families. Pediatric hospital-based care has been affected both directly and indirectly by these changes in child and adolescent psychiatric care with the hospital setting being impacted in intended and unintended ways. We convene this forum, through the American Academy of Child and Adolescent Psychiatry, to reflect on the experiences, both successes and challenges, as well as lessons learned, from leaders in hospital-based child and adolescent psychiatric care across different localities and along the continuum of COVID-19 response planning. 

Objectives

• Reflect upon current and past experiences at several health systems in the administrative, clinical, education, and staff-related stress response activities in response to the COVID-19 pandemic.
• Examine innovations in care, training, and support to health system workflow and wellness in the setting of the current health crisis.
• Identify the potential impacts of the COVID-19 response among health systems to current and future mental health practice in pediatric hospital-based settings.
• Discuss anticipated and unanticipated challenges in the pediatric hospital-based response to COVID-19 as well as lessons learned that will inform continued and future response to this pandemic.

Outline of Forum

• Introduction of Forum and Speakers 
• Address from AACAP President
• Review of Hospital-Based Care Along Four Domains 

• Each domain will include a 10 minute presentation and 20 minutes for questions and discussion

• Administrative Issues and Staffing
• Clinical Service Delivery
• Training and Education 
• Staff Stress Response and Psychological Trauma

Moderators

Gabrielle Carlson, MD
AACAP President

Patrick Kelly, MD
Co-Director of the Child and Adolescent Psychiatric Emergency Unit
Co-Director, Child and Adolescent Consultation / Liaison Services
Division of Child and Adolescent Psychiatry, Department of Psychiatry, Harbor-UCLA Medical Center

Maryland Pao, MD
Clinical & Deputy Scientific Director, National Institutes of Mental Health
National Institutes of Health Bethesda, Maryland

Speaker Panel

Khyati Brahmbhatt, MD
Director- Child and Adolescent Psychiatry Consultation-Liaison Service (PPACT)
Associate Clinical Professor, Department of Psychiatry & Langley Porter Psychiatric Institute
Weill Institute for Neurosciences, Benioff Children's Hospital,
Weill Institute for Neurosciences, Benioff Children's Hospital, University of California, SF

Beau Carubia, MD
Medical Director Consultative Division, Pediatric Mental Health Institute, Children’s Hospital Colorado
Associate Program Director Child and Adolescent Psychiatry Fellowship Program
Assistant Professor, Department of Psychiatry, University of Colorado School of Medicine

Vera Feuer, MD
Director, Pediatric Emergency Psychiatry and Behavioral Health Urgent Care, Cohen Children's Medical Center
Associate Professor, Psychiatry and Emergency Medicine, Hofstra-Northwell School of Medicine

Anik Jhonsa, MD
Medical Director of Emergency Psychiatric Services, Children's Hospital of Philadelphia
Assistant Training Director, Child and Adolescent Psychiatry Fellowship Program
Clinical Associate Professor, Department of Psychiatry Perelman School of Medicine, University of Pennsylvania

Nasuh Malas, MD, MPH
Director, Pediatric Consultation-Liaison Psychiatry
Assistant Professor, Division of Child and Adolescent Psychiatry, Department of Psychiatry
Assistant Professor, Department of Pediatrics
C.S. Mott Children's Hospital, University of Michigan Health System

Matthew B. Perkins, MD, MBA, MPH
Medical Director, Children and Family Services
New York State Office of Mental Health

Using the Current Public health Crisis as an Opportunity for Advocacy

The COVID-19 pandemic is significantly impacting the mental health of children and adolescents. Anxiety about illness and trauma, grief related to loss, financial stressors, and disruptions in learning are just some of the experiences that have affected our youth. The public health crisis has also called attention to disparities in health and health care that predate the public health crisis but are clearly exacerbating negative health outcomes related to COVID-19 and impacting an individuals’ ability to access needed care. 

Advocacy initiatives from various stakeholders have been instrumental in organizing the response to COVID-19. Physician voices have informed many health care decisions, including access to PPE, allocation of health care spending, and expansion of telemedicine services. Child and adolescent psychiatrists are in a unique position to not only advocate on behalf of patients encountered in the clinical setting but also engage in mental health advocacy in order to create system-level change that will advance health equity, transform the delivery of health care, and improve the mental health of our nation’s youth. The call to action for AACAP members is now, as we respond to escalating mental health needs in the wake of the pandemic; anticipate the impact of schools reopening; and identify political champions for children’s mental health in advance of the November elections.

Objectives

• Recognize that structural factors affect policy and practices that shape the delivery of mental health treatment and cause downstream effects that impact the mental health of children and adolescents.
• Examine the ways in which mental health advocacy can inform structural change and positively influence health care policy, using telemedicine as an example.
• Describe the steps that are essential in an effective advocacy campaign.
• Identify the advocacy resources and opportunities that exist within AACAP to support engagement in mental health advocacy initiatives.
• Apply the knowledge and skills learned to develop and act on a personal advocacy action prior to the November 2020 election.

Outline of Forum

• Introduction of Forum and Speakers  
• Address from AACAP President
• Structural Competency and Advocacy
• Steps for An Effective Advocacy Campaign: Improved Access to Telemedicine in a Pandemic
• Breakout Rooms: Advocacy training led by Advocacy Committee members and AACAP staff
• Q&A with Panel  

Speakers

Gabrielle Carlson, MD
AACAP President

Deb Koss, MD
Co-Chair, AACAP Advocacy Committee

Melvin Oatis, MD
Private Practice
AACAP Chair, Assembly of Regional Organizations of Child and Adolescent Psychiatry

Karen Pierce, MD
Co-Chair, AACAP Advocacy Committee

Ronald Szabat, Esq.
AACAP, Director of Government Affairs & Clinical Practice

Cynthia Whitney, MPA
AACAP, Deputy Director of Congressional and Political Affairs

Emily Rohlffs
AACAP, State Advocacy & ROCAP Engagement Manager