From the Practice Directorate
New Health and Behavior Assessment CPT Codes Take Effect
With the advent of six new Current Procedural Terminology (CPT) codes effective January 2002, psychologists have a more accurate, refined way of billing for services provided to patients with a physical health diagnosis. New codes for health and behavioral assessment and intervention services apply to behavioral, social, and psychophysiological procedures for the prevention, treatment or management of physical health problems.
Developing the new codes involved the combined efforts of APA’s Practice Directorate and the Interdivisional Healthcare Committee (IHC), representing APA divisions 17,22, 38, 40 and 54, and constitutes a milestone in the recognition of psychologists as health care providers.
Until now, almost all intervention codes used by psychologists involved psychotherapy and required a mental health diagnosis, such as under the DSM-IV. In contrast, health and behavior assessment and intervention services focus on patients whose primary diagnosis is physical in nature.
The codes capture services addressing a wide range of physical health issues, such as patient adherence to medical treatment, symptom management, health-promoting behaviors, health-related risk-taking behaviors, and overall adjustment to physical illness. In almost all of these cases a physician will already have diagnosed the patient’s physical health problem. Physical health diagnoses are typically represented by ICD-9 CM codes (see http://www.mcis.duke.edu/standards/termcode/icd9/1tabular.html or http://www.cdc.gov/nchs/icd9.htm).
If a psychologist is treating a patient with both a physical and mental illness he or she must pay careful attention to how each service is billed. The health and behavior codes cannot be used for psychotherapy services addressing the patient’s mental health diagnosis nor can they be billed on the same day as a psychiatric CPT code. The psychologist must report the predominant service performed.
Use of the codes will enable reimbursement for the delivery of psychological services for an individual whose problem is a physical illness and does not have a mental health diagnosis. Since these codes are new, reimbursement rates from the private sector have not been determined. However, it is important that psychologists begin to use these codes now to accurately capture the services provided.
Use of the six new codes will enable the delivery of psychological services without requiring a mental health diagnosis for an individual whose problem is actually a physical illness. Since these codes are new, reimbursement rates from the private sector have not been determined. However, it is important that psychologists begin to use these codes now to accurately capture the services provided.
The health and behavior assessment and intervention codes:
96150 – the initial assessment of the patient to determine the biological, psychological, and social factors affecting the patient’s physical health and any treatment problems.
96151 – a re-assessment of the patient to evaluate the patient’s condition and determine the need for further treatment. A re-assessment may be performed by a clinician other than the one who conducted the patient’s initial assessment.
96152 – the intervention service provided to an individual to modify the psychological, behavioral, cognitive, and social factors affecting the patient’s physical health and well being. Examples include increasing the patient’s awareness about his or her disease and using cognitive and behavioral approaches to initiate physician prescribed diet and exercise regimens.
96153 – the intervention service provided to a group. An example is a smoking cessation program that includes educational information, cognitive-behavioral treatment and social support. Group sessions typically last for 90 minutes and involve 8 to 10 patients.
96154 – the intervention service provided to a family with the patient present. For example, a psychologist could use relaxation techniques with both a diabetic child and his or her parents to reduce the child’s fear of receiving injections and the parents’ tension when administering the injections.
96155 – the intervention service provided to a family without the patient present. An example would be working with parents and siblings to shape the diabetic child’s behavior, such as praising successful diabetes management behaviors and ignoring disruptive tactics.
Practice Directorate Helps Practitioners with Federal Privacy Rule
The APA Practice Organization, an affiliate of APA that advocates for the professional interests of practitioners, is engaged in a number of activities to help practitioners understand and comply with requirements of the privacy rule resulting from the Health Insurance Portability and Accountability Act (HIPAA). As part of this process, the Practice Organization is pursuing ongoing dialogue with practitioners and with the U.S. Department of Health and Human Services to help apply the rules to psychology practice. The initial deadline for compliance with the privacy rules is April 14, 2003.
The Practice Organization is also joining forces with the APA Insurance Trust, for which HIPAA is a relevant area given the Trust’s concern with practitioner risk management issues. The APA Practice Organization–Insurance Trust collaboration involves the development of compliance resources including practice assessment tools, model policies and procedures, and forms and checklists tailored to psychology practice.
Among the additional major related directorate initiatives in progress as of February:
In March, the APA Practice Organization will mail free of charge to all APA members who pay the special assessment a detailed publication entitled, “Getting Ready For HIPAA: What You Need to Know.”
Special assessment payers also will receive the Winter 2001-2002 issue of the Practice Directorate’s Practitioner Focus newsletter, a special issue on HIPAA compliance.
Certain of the psychology leaders attending the directorate’s March 2002 State Leadership Conference will participate in a “train the trainers” workshop featuring a Power Point presentation on what psychologists need to know about HIPAA.
Call for Nominations: Advisory Committee on Colleague Assistance
The Board of Professional Affairs (BPA) seeks nominations for its Advisory Committee on Colleague Assistance (ACCA) for two three-year terms starting January 2003. ACCA is an ad hoc advisory committee to BPA. Its mission includes: (1) investigating the unique needs of psychologists for professional health and well-being, (2) promoting the development and continuation of state-level colleague assistance programs and peer assistance networks, and (3) developing relationships between state ethics committees, licensing boards, and state colleague assistance programs. Participation in ACCA requires a significant time commitment including two meetings per year in Washington, DC, work on individual projects, and conference calls.
Nominees are sought with experience in prevention of professional stress and distress, occupational health for psychologists, forensics, and ethics. Nominees who have previously worked on these issues with an ethics committee, licensing board, or state psychological association are encouraged. BPA and ACCA seek candidates who will enhance the diversity of the advisory committee. Divisions and APA members are asked to submit their nominations to Chris McLaughlin in the APA Practice Directorate no later than June 1, 2002.
The Board of Professional Affairs (BPA) seeks nominations for up to three three-year terms on its Committee on Professional Practice and Standards (COPPS) starting January 2003. COPPS is a continuing committee to BPA. Its mission includes (1) developing and recommending to BPA standards and guidelines for providers of psychological services; (2) together with BPA, providing assistance to other APA bodies developing practice guidelines; and (3) monitoring, evaluating, and developing information regarding the scientific and professional aspects of psychological services.
While all applicants will be seriously considered, those with experience in guidelines and standard development, forensic psychology, in APA governance, and those who have legal and/or ethics backgrounds are particularly encouraged to apply. BPA seeks candidates who will enhance the diversity of the Committee. Well-developed writing and information research skills are an asset to the Committee.
Participation in COPPS requires a significant annual time commitment including three meetings in Washington, DC, work on individual projects, and conference calls. Members of other APA standing or continuing Boards or Committee may not serve on COPPS. Divisions and APA members are asked to submit their nominations to Chris McLaughlin in the APA Practice Directorate no later than June 1, 2002.