New codes for collaborative care

This article appears in the 5/25/2018 edition of Medical Economics

Q:I am referring more of my patients to psychiatrists to monitor their behavioral health conditions. However, their mental health issues impact their other medical conditions, so I wanted to know if there is a way that I can stay involved in the care of these patients from a behavior health perspective. How would this be done from a coding perspective?A: There are three new codes for Collaborative Care Management (CoCM).  While these aren’t new services, there are new codes for 2018 with more detailed information on their use.

Psychiatric collaborative care management services describe care reported by a physician or other qualified health care professional (QHCP) overseeing a behavioral healthcare manager and psychiatric consultant who provide 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.

The psychiatric consultant contracts directly with the physician or other QHCP to render the consultation portion of the service. Patients are generally referred to a behavioral healthcare manager for assistance in receiving treatment for newly diagnosed conditions that have been unresponsive to traditional or standard care provided in a non-psychiatric environment or who need additional examination and evaluation before a referral to a psychiatric care setting.

Code 99492 replaces HCPCS Level II code G0502; 99493 replaces G0503; and 99494 replaces G0504.

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….”
These codes 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.  Since these are time-based codes, the team’s total time spent each month needs to be documented in the progress note in order to support the code(s) billed.  Additionally, the tools utilized and the treatment modifications, when appropriate, should also be documented.  Keep in mind that 99494 is an “add-on” code and can be billed in addition to 99492 for the initial month’s service and 99493 for any subsequent month’s service.

Coding Tip
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) are not included in the time applied to psychiatric collaborative care management services (99492-99494) and 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.
These services 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.
 

Three new, time-based codes report CoCM services:
99492   Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral healthcare manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified healthcare professional
99493   Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral healthcare manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified healthcare professional
+99494   Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral healthcare manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified healthcare professional (List separately in addition to code for primary procedure)

Clinical Examples
In each instance, the patient’s primary care physician recommends that he/she be enrolled in the psychiatric CoCM services program.

99492
Adult: A 55-year-old female, who is separated from her husband and has no children at home, has been feeling more fatigued, not sleeping well, and not taking her medicines for hypertension and diabetes. She also worries a lot about her future. The patient is diagnosed as having a behavioral health disorder.

Child/Adolescent: A 15-year-old child is brought in by a parent because of concerns about social withdrawal, anxiety, diminished school performance, and substance abuse. The patient is diagnosed as having a behavioral health disorder.

99493 – Once enrolled in the CoCM services program, if the patients above continue to have symptoms, 99493 would be appropriate to bill for subsequent month(s) of service.

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