An estimated 54 million Americans are affected by some form of mental disorder in a given year, according to Mental Health America. Psychiatric collaborative care management (CoCM) is a proven strategy for treating mood disorders. In 2018, medical coding outsourcing companies are helping providers report CoCM with new codes that replaced the 2017 G-codes for behavioral health services.
Mental Health Disorders – Causes and Symptoms
A mental illness affects a person’s thinking, feeling or mood and causes mild to severe disturbances in thought and/or behavior. It may affect the person’s ability to cope with everyday demands and to interact with others. Experiences may vary among people even if they have the same diagnosis. The most common mental illnesses are depression, alcohol/substance abuse, anxiety disorders, obsessive compulsive disorder (OCD), bipolar disorder, attention deficit/hyperactivity disorder (ADHD), and eating disorders.
Factors that trigger mental illnesses include excessive stress, a series of traumatic events, genetic factors, biochemical imbalances, or a combination of these. Symptoms generally include changes in mood, personality, personal habits and/or social withdrawal. Proper care and treatment can help people cope successfully or recover from a mental or emotional disorder.
Collaborative Care Approach for Mental Health Conditions
The American Psychiatric Association (APA) recommends the psychiatric collaborative care management as the ideal option to meet the needs of people with mental health problems. CoCM delivers effective and efficient care by integrating behavioral health and general medical services. The APA notes that research has shown that this care model can improve patient outcomes, save money, and reduce stigma related to mental health.
The essential elements of the collaborative care approach are as follows:
- Team driven – Coordinated care is delivered by a multidisciplinary group of healthcare delivery professionals empowered to work at the top of their training.
- Population-focused – The CoCMteam takes responsibility for the provision of care and health outcomes of a defined population of patients.
- Measurement-guided – Systematic disease-specific patient-reported outcome measures (such as symptom rating scales) are used to make clinical decisions.
- Evidence-based – Scientifically proven treatments are adapted within an individual clinical context to achieve improved health outcomes.
New Time-based Codes for CoCM in 2018
A recent Medical Economics article reported on the new 2018 CoCM codes and their use. The article describes psychiatric collaborative care management services as: “care reported by a physician or other qualified health care professional (QHCP) overseeing a behavioral healthcare manager and psychiatric consultant who provides a behavioral health assessment, including establishing, starting, revising, or monitoring a plan of care as well as providing brief interventions to a patient diagnosed with a mental health disorder”.
Per the American Psychiatric Association, psychiatric CoCM services:
“….typically [are] provided by a primary care team consisting of a primary care physician and a care manager who work in collaboration with a psychiatric consultant, such as a psychiatrist. Care is directed by the primary care team and includes structured care management with regular assessments of clinical status using validated tools and modification of treatment as appropriate. The psychiatric consultant provides regular consultations to the primary care team to review the clinical status and care of patients and to make recommendations….”
In 2018, there are three new time-based CPT codes 99492-99494 for Collaborative Care Management (CoCM) to replace three 2017 HCPCS Level II codes and more detailed information on their use.
- 99492 replaced code G0502
99492 Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of BHCM activities, in consultation with a psychiatric consultant, and directed by the treating physician or other QHP, with the following required elements:
- outreach to and engagement in treatment of a patient directed by the treating physician or other QHP;
- initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan;
- review by the psychiatric consultant with modifications of the plan if recommended;
- entering patient in a registry and tracking patient follow-up and progress using the registry, with appropriate documentation, and participation in weekly caseload consultation with the psychiatric consultant; and
- provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing and other focused treatment strategies.
- 99493 replaced G0503
99493 Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of BHCM activities, in consultation with a psychiatric consultant, and directed by the treating physician or other QHP, with the following required elements:
- tracking patient follow-up and progress using the registry, with appropriate documentation;
- participation in weekly caseload consultation with the psychiatric consultant;
- ongoing collaboration with and coordination of the patient’s mental health care with the treating physician or other QHP and any other treating mental health providers;
- additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant;
- provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing and other focused treatment strategies;
- monitoring of patient outcomes using validated rating scales; and
- relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment.
- +99494 replaced G0504
+99494 Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of BHCM activities, in consultation with a psychiatric consultant, and directed by the treating physician or other QHP (List separately in addition to code for primary procedure). Code 99494 is an add-on code and should be used in conjunction with 99492, 99493).
Reporting CoCM Services – Points to Note
Codes 99492-99494 are reported by the treating physician or qualified health care professional (QHP). The American Academy of Family Physicians (AAFP) informs that the psychiatric consultant’s services are included in the codes and the psychiatric consultant is paid by the treating physician based on a contractual arrangement.
Psychiatric CoCM codes are time-based and the CPT midpoint rule applies. AAFP cautions that time spent on PCCM activities that occur while the patient is in observation or inpatient hospital status should not be included. Psychiatric CoCM services to coordinate care with the emergency department may be included in the time of service reported.
The Medical Economics article provides the following guidelines on the use of the new CoCM CPT codes:
- Codes 99492-99494 include the time spent by the entire team in collaboration to assess the patient’s mental health and the impact to his/her overall health. As these codes are time-based, the total time spent each month by the team has to be documented in the progress note in order to support the code(s) billed.
- The documentation should also include the tools utilized and the treatment modifications, when appropriate.
- Add-on code 99494 can be billed in addition to 99492 for the initial month’s service and 99493 for any subsequent month’s service.
- The time applied to psychiatric collaborative care management services (99492-99494) does not include time spent providing smoking and tobacco use cessation counseling (99406-90407) or alcohol and/or substance abuse structured screening and brief intervention services (99408-99409). These services should be separately reported using the appropriate code.
- Psychiatric collaborative care services are provided under the direction of a treating physician during a calendar month. They are reported by the treating physician and include the services provided, the behavioral healthcare manager, and the psychiatric consultant, who has contracted directly with the treating physician to provide consultation.
ICD-10 Codes for Mental, Behavioral and Neurodevelopmental Disorders
Psychiatric CCM services reported should be linked to the appropriate diagnoses codes. The 2018 ICD-10 codes for mental, behavioral and neurodevelopment disorders (F01-F99) are:
- F01-F09 Mental disorders due to known physiological conditions
- F10-F19 Mental and behavioral disorders due to psychoactive substance use
- F20-F29 Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders
- F30-F39 Mood [affective] disorders
- F40-F48 Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders
- F50-F59 Behavioral syndromes associated with physiological disturbances and physical factors
- F60-F69 Disorders of adult personality and behavior
- F70-F79 Intellectual disabilities
- F80-F89 Pervasive and specific developmental disorders
- F90-F98 Behavioral and emotional disorders with onset usually occurring in childhood and adolescence
- F99-F99 Unspecified mental disorder
With the success of the CoCM approach, treating physicians are referring more patients to psychiatrists for proactive monitoring and management of diagnosed behavioral health conditions. The support of an experienced cardiology billing company can go a long way in reporting these services correctly for maximum reimbursement.