Behavioral Medicine Medical Coding

by | Last updated Feb 28, 2023 | Published on Dec 9, 2010 | Specialty Coding

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Six reimbursement codes were added to the CPT coding system in 2002, to be used to bill for behavioral, social, and psychophysiological services provided for the prevention, treatment or management of physical health problems. These are known as HBA (health and behavioral assessment) codes. Behavioral medicine codes are meant for use by non-physician providers such as advanced practice nurses (APNs), psychologists, licensed clinical social workers and other non-physician healthcare providers. If physicians provide the same services, they should use the Evaluation and Management codes.

The introduction of these codes has provided psychologists with a more exact and advanced way of billing for services provided to patients with a physical health diagnosis. The patients covered under these services are not those with a psychiatric problem, but whose behavioral, emotional, cognitive, or social functioning in some way affects the prevention, treatment or management of a physical health problem.

Coding Classification

  • Health and behavior assessment and reassessment — 96150 and 96151

These codes are assigned for services such as clinical interview, observation, monitoring or even questionnaires.

  • Four health and behavior intervention services for improving a patient’s health
  • individual (96152)
  • group (96153)
  • family and patient (96154)
  • family alone (96155)

Services in this category include self-monitoring or teaching cognitive-behavioral techniques, coping and social skills, relaxation, visualization, communication and conflict resolution, smoking cessation, diet and exercise, and relapse prevention prescribed by a physician.

2 of these codes, 96150 and 96152, are billed in 15-minute increments, while time parameters are not specified for the remaining 4 services.

What Is Different about HBA Codes?

HBA services are different from E&M services in that these are provided without satisfying requirements such as evaluating medical history, carrying out a medical examination and arriving at a medical decision. HBA services are reimbursed differently from E&M services, the latter being associated with an increased work value and hence a higher fee.

An HBA Code Cannot Be Used

  • for services offered for a patient with a psychiatric disorder
  • when carrying out psychological testing
  • when an evaluation and management (E&M) service is provided on the same day
  • for self-administered questionnaires completed by patients before or after the service is provided, that is, without the service provider present

The section of the CPT manual entitled “Health and Behavior Assessment and Intervention” lists these code numbers and their descriptions. These are not however, listed in the psychiatric section of the CPT manual.

How to Record Diagnoses for Behavioral Medicine Services

When reporting behavioral medicine services, the diagnosis such as a medical symptom/condition made by the primary healthcare giver has to be stated. If any behavioral/mental conditions associated with the primary diagnosis are identified and managed during the visit, these have to be signified using appropriate ICD-9 codes. However, if the referral has been made for an already diagnosed mental health condition, suitable DSM codes are to be used instead of the ICD-9 codes. V-codes that particularly signify behavioral conditions may also need to be considered.

Five out of the six codes, excepting 96155, are reimbursed by Medicare. Private health insurance providers have also started reimbursing these codes. However, service providers have to verify with private health insurers regarding their payment policies.

Medical Coding Firms to Reduce Your Workload

Busy healthcare professionals can entrust their behavioral medicine medical coding requirements to reliable and reputable coding firms, and benefit from considerably increased reimbursement, reduced denials and reduced workload. The coding process is rather complex and the advantage is that these firms usually have experienced professionals well-versed in

  • Hospital / inpatient coding
  • Emergency room e-code evaluation
  • Medical coding audits
  • Payer specific coding requirements
  • DRG/ICD-9-CM coding validations
  • CPT coding

In addition, services offered are HIPAA compliant, quality assured, accurate and come with customizable turnaround time.

Rajeev Rajagopal

Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.

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