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New CPT codes for behavioral health services take effect Jan. 1 :

November 2, 2017

Editor’s note:This is the second of two articles on Current Procedural Terminology (CPT) code changes for 2018. The first article is available athttp://www.aappublications.org/news/2017/10/03/Coding100317.

Psychiatric collaborative care management (PCCM) as described by Current Procedural Terminology (CPT) 2018 reflects behavioral health services delivered via a specific evidence-based model. Care is managed by a behavioral health care manager (BHCM), who has master’s/doctoral-level education or specialized training in behavioral health, under direction of a treating physician or qualified health care professional (QHP) in consultation with a medical professional trained in psychiatry or behavioral health and qualified to prescribe the full range of medications.

PCCM codes 99492-99494 are reported only by the treating physician or QHP; the psychiatric consultant’s services are included in the codes. The treating physician pays the psychiatric consultant through a contractual arrangement.

The PCCM codes are time-based with the CPT midpoint rule applying (see table). Do not include any time in PCCM activities that occur while the patient is in observation or inpatient hospital status. PCCM activities to coordinate care with the emergency department may be included in the time of service reported.

PCCM definitions

CPT defines terms used to describe PCCM services. These include:

  • episode of care
  • treating physician or QHP
  • BHCM
  • psychiatric consultant

PCCM codes

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 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 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) (Use 99494 in conjunction with 99492, 99493)

Example of PCCM

A 17-year-old patient is seen for follow-up of previously diagnosed major depression for which she and her parents refused medication. The patient has been seeking counseling from her school counselor, but a structured depression screening instrument score indicates no improvement in her depression.

Dr. Mike discusses with the patient and her parents a new service offered in his practice. A registered nurse (i.e., BHCM) with specialized training in behavioral health care will be providing care management for patients with emotional and behavioral health conditions in collaboration with Dr. Mike and a psychiatrist in another town. The patient and her family agree to receive PCCM services.

The same day, the BHCM assesses the patient’s general emotional and behavioral health using a standardized instrument and advises the patient that she will call in two days with a proposed treatment plan. This encounter took 20 minutes. The BHCM then discusses the patient’s history and assessment with the consulting psychiatrist as part of her weekly collaboration session. The consulting psychiatrist affirms the BHCM’s assessment that the patient not only has major depressive disorder but also suffers from social anxiety disorder.

Ten minutes of psychiatric collaboration discussing her assessment of the patient and creating a care plan and another five minutes in follow-up with Dr. Mike are documented.

The BHCM then calls the patient and speaks with her and her mother regarding the new diagnoses and care plan. With their agreement to the plan, the nurse uses a secure patient portal to share the written care plan with the mom and school counselor. Another 15 minutes of PCCM activities is documented.

Throughout the remainder of the calendar month, the BHCM reassesses the patient’s condition, monitors the care plan, collaborates with the psychiatrist weekly and communicates/consults with Dr. Mike regarding her progress. A registry of patients receiving PCCM services also is updated throughout the month. The BHCM documents a total of 60 minutes.

Because this is the initial month of PCCM services what is reported and by whom?

99492 is reported by Dr. Mike for PCCM services in this calendar month and linked to diagnoses for moderate major depression (F32.1) and social anxiety disorder (F40.10).

Use of validated rating scales in the assessment and re-assessments during provision of PCCM services is not separately reported, but the time spent in assessment and/or re-assessment is included in the time of PCCM service.

Becky Dolan contributed to this article. For coding and billing questions, email AAP coding staff at aapcodinghotline@aap.org

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