NPI - provider category

[Guest guest]

The forwarded messages below are correspondence between myself and the

organization that oversees the creation of NPI provider codes. I

thought it may be of interest to other members.

After applying for an NPI #, I was dismayed to find that art

therapists were included under the category of rehabilitation therapy,

even though all other NYS licensed mental health professionals were

categorized under behavioral health. I first attempted to create a new

Creative Arts Therapy provider code under behavioral health, but the

organization that oversees the process rejected this as redundant,

because several of the creative modalities already have provider

codes. I then attempted to have art therapy moved to behavioral health

by offering a suitable rationale, however this was rejected as well,

as per the comments forwarded below.

My feeling was that an NPI # that reflected our work in mental health

would encourage more insurance companies to reimburse us for our work

(though I'm not certain there is a direct relationship between the

two). I don't have any ideas about proceeding further, so if anyone

else does I'm all ears. Thanks

-Jon Borah

---------- Forwarded message ----------

Date: Wed, Dec 10, 2008 at 2:53 PM

Subject: Re: FW: Follow up to Health Care Provider Taxonomy code request

To: " Kocher, Gail "

Dear Ms. Kocher,

Thank you very much for your detailed reply. I appreciate that the

matter was considered in depth even though I disagree with the outcome.

Sincerely,

Jonathon Borah

On Wed, Dec 10, 2008 at 1:39 PM, Kocher, Gail

wrote:

Mr. Borah †"

The category that art therapists are listed under is a collection

of several different provider types, i.e. Respiratory, Developmental,

Rehabilitative, AND Restorative. Each code falls into at least one of

the four possibilities within this overall category. For examples:

Respiratory: Respiratory therapist,

Developmental: Developmental therapist

Rehabilitative and/or Restorative: Occupational therapist, Art

therapist

The Health Care Provider Taxonomy code set does not distinguish

between the disciplines two schools of thought: art psychotherapy or

art as therapy, both of which are ultimately restorative and may be

rehabilitative. That distinction is outside the realm and purview of

the code set.

The NUCC and the Code Set Subcommittee did discuss the concerns

raised regarding behavioral health listing and determined that based

upon documented definitions of art therapy as being used in both

mental health and rehabilitative situations, it most appropriate to

have the code remain where it is currently in the code set in order to

encompass both possibilities. The definition identifies that the area

of specialty includes mental, i.e. behavioral health. Ultimately, the

designation of behavioral health is determined in how a Payer

enrolls/credentials a provider and whether they categorize a provider

specialty as behavioral health only or more broadly. The taxonomy code

does not preclude a Payer from listing art therapy only in their

behavioral health provider grouping.

The NUCC protocol is available publically on the NUCC website,

www.nucc.org, and includes the Code Set Subcommittee documentation.

Thank you

Gail Kocher

NUCC Code Set Subcommittee Co Chair

From: Spector

Sent: Friday, November 14, 2008 8:43 AM

To: Kocher, Gail

Subject: FW: Follow up to Health Care Provider Taxonomy code request

From: Jonathon Borah

Sent: Friday, November 14, 2008 12:49 AM

To: Spector

Subject: Re: Follow up to Health Care Provider Taxonomy code request

Ms. Spector,

Thank you for your reply and update. The problem lies in that art

therapists are currently categorized as rehabilitation service

providers, as opposed to behavioral health service providers. I'm not

sure if that category designation was applied by your organization,

but it is erroneous and I'm hoping it can be changed. I thought that

adding a new service provider to the behavioral health category which

encompasses art therapists, music therapists, drama therapists, and

dance movement therapists, would be easier than changing the current

category for art therapists (and others), but perhaps that is not the

case.

Surely your organization can find information to support this

claim that art therapists should be re-categorized as behavioral

health service providers, even if just by simply researching the

website of AATA (www.arttherapy.org), the national professional

organization for art therapy. As you say, licensure is a local issue,

but the website of AATA reflects the national professional

considerations of art therapists and clearly states:

" Art therapy is a mental health profession that uses the creative

process of art making to improve and enhance the physical, mental and

emotional well-being of individuals of all ages. It is based on the

belief that the creative process involved in artistic self-expression

helps people to resolve conflicts and problems, develop interpersonal

skills, manage behavior, reduce stress, increase self-esteem and

self-awareness, and achieve insight. "

And of course that is the beginning of a detailed explanation that

describes the profession of art therapy as mental health practice.

Apparently whether it is licensed on a local level does not factor

into your designation, so the description on a national level on this

website is more germane to the discussion (by your own rules).

I only make this point because I would like to be designated as

providing the service that is most representative of the work I am

doing. I hope that you too would like to rectify this error, and I

would like to know what I can do to facilitate this correction. Also,

I would like to know if there are records or minutes that describe the

process by which these matters are considered by your organization.

Once again, I appreciate your follow-up and hope to hear from you

in a timely manner. Thank you in advance for your consideration.

Sincerely,

Jonathon Borah, MPS, ATR-BC, LCAT

On Thu, Nov 13, 2008 at 3:25 PM, Spector

wrote:

Jonathon,

You previously were in contact with Moncada regarding a

request to have a Health Care Provider Taxonomy code added for

Creative Arts Therapist under Behavior Health & Social Service

Providers. is on medical leave, so I am responding in her

absence.

The NUCC reviewed your request. We were unable to find a separate

distinction between an Art Therapist and Creative Arts Therapist. In

our ongoing maintenance of the code set, we are aware that states may

recognize different licensure or certification requirements for

different providers and may have different terms to identify the

providers. The code set must address provider roles at a national

level and cannot accommodate variations among states. Therefore, the

NUCC has denied your request to add an additional code because there

is an existing code for Art Therapist.

If you have any information that would dispute the findings of the

NUCC and show that Creative Arts Therapists are a separate and

distinct role from Art Therapists, please feel free to send us it and

we will reconsider your request.

Spector, RN MSC

National Uniform Claim Committee