EM Coding Alert

Remember: New CPT® code 99493 will replace HCPCS option G0503.

For January 1, 2018, CPT® 2018 will add five new behavioral health integration (BHI) and behavioral healthcare management codes to the evaluation and management (E/M) section. However, each of the various components to these codes can be challenging.

Read on to make sure you understand exactly what information needs to be in the medical documentation so you report these codes correctly.

Brush Up on the Background of These New Codes

In 2017, CMS introduced several HCPCS codes that "CMS created for 2017, knowing that the CPT^® codes would not be available until 2018," according to Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

As of January 2018, these HCPCS codes will be deleted making way for the brand-new CPT^® code choices.

Additions: In 2018, for collaborative care management (CoCM) services, you will be able to report the following:

• 99492 (Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional ...), which replaces G0502, which has the same code descriptor.
• 99493 (Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional...), which replaces G0503, which has the same code descriptor.
• 99494 (Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional (List separately in addition to code for primary procedure)), which replaces G0504, which has the same code descriptor.

For cognitive-assessment services, 99483 (Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home ...) will replace G0505 (Cognition and functional assessment using standardized instruments with development of recorded care plan for the patient with cognitive impairment, history obtained from patient and/or caregiver, in office or other outpatient setting or home or domiciliary or rest home).

For care management-focused BHI, 99484 (Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month ...) will replace G0507, which has the same code descriptor.

Mark Down These Requirements for 99492

You will report 99492 for the initial psychiatric CoCM service. As indicated by the descriptor, this service represents the "first 70 minutes in the first calendar month of behavioral healthcare manager activities." All of the following components are required to report this code correctly, and they must be clearly documented in the patient's medical record:

• The treating physician or other qualified healthcare professional must facilitate the outreach to and engagement in the patient's treatment
• Performing the initial assessment of the patient, which includes administering validated rating scales and developing an individualized treatment plan
• The psychiatric consultant reviews the patient's treatment plan and makes changes, if recommended
• Putting the patient in a registry and using that registry to track his follow-up and progress. This includes providing the correct medical documentation and participating in a weekly caseload consultation with the psychiatric consultant.
• Directing brief interventions using evidence-based techniques like behavioral activation, motivational interviewing, and other focused treatment strategies.

Don't Forget These Components of 99493

For subsequent psychiatric CoCM, the first 60 minutes in a subsequent month of behavioral healthcare manager activities, you will report 99493. All of the following components should be documented by the provider as each are required to report this code:

• Using the registry to track the patient's follow-up and progress, as well as providing the appropriate medical documentation
• Participating in a weekly caseload consultation with the psychiatric consultant
• Conducting additional reviews of the patient's progress and making any recommendations for changes in his treatment, including medications, based upon the psychiatric consultant's recommendations
• Providing brief interventions using evidence-based techniques like behavioral activation, motivational interviewing, and other focused treatment strategies
• Using validated rating scales to monitor the patient's progress
• Collaborating with and coordinating the patient's mental healthcare with the treating physician, other qualified healthcare professional, and any other treating mental health providers.
• Performing relapse prevention planning with the patient while he experiences remission of his symptoms and/or other treatment goals and prepares to be discharged from active treatment.

Ensure You Always Use This Add-on Code Correctly

The descriptor for the new CoCM code +99494 indicates that you should report it for "initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral healthcare manager activities."

As with other add-on codes, +99494 adds that you should "list it separately in addition for the code for the primary procedure."

Bonus tip: Codes 99492, 99493, and +99494 all specify that the psychiatric collaborative care management must be performed "in consultation with a psychiatric consultant and directed by the treating physician."

"This should all be evident within the medical record documentation of the clinical staff or physician as applicable," says Suzan Hauptman, MPM, CPC, CEMC, CEDC AAPC fellow, senior principal of ACE Med Group in Pittsburgh.

Recognize These Cognitive-Assessment Service Components

For 99483, the physician typically spends 50 minutes face-to-face with the patient and/or family or caregiver. According to the descriptor, 99483 requires all of the following components to be performed and documented into the medical record:

• A cognition-focused evaluation of the patient, which includes a pertinent history and exam
• Moderate or high complexity medical decision-making (MDM)
• Functional assessment, like the basic and instru­mental activities of daily living, which includes the patient's decision-making capacity
• Using standardized instruments to determine the patient's stage of dementia such as the functional assessment staging test or the clinical dementia rating
• Performing medication reconciliation and reviewing the patient for high-risk medications
• Assessing the patient for neuropsychiatric and behavioral symptoms, which includes depression and using standardized screening instrument(s)
• Evaluating the patient's safety, which includes his home and ability to operate a motor vehicle
• Identifying the patient's caregiver(s), including the caregiver's knowledge, needs, social support, and the caregiver's willingness to perform certain caregiving tasks
• Creating, updating/revising, or reviewing an Advance Care Plan (ACP)
• Establishing a written care plan, which includes the initial plans to address the patient's neuropsychiatric and neuro-cognitive symptoms and functional limitations. This component also includes the physician referring the patient and/or caregiver to community resources like rehabilitation services, adult day programs, and support groups.

Master the Requirements for This BHI Code

Care management-focused BHI 99484 indicates at least 20 minutes of clinical staff time, directed by a physician or other qualified healthcare professional, per calendar month. The required components are as follows:

• The patient's initial assessment or follow-up monitoring, which includes using applicable validated rating scales
• Behavioral healthcare planning in regards to the patient's behavioral and or psychiatric health problems, which includes revising the plan for patients who do not progress or whose status changes
• Facilitating and coordinating the patient's treatment like psychotherapy, pharmacotherapy, counseling, and/or psychiatric consultation
• Performing the patient's continuity of care with a designated member of the care team.

Jan Blanchard, CPC, CPMA, pediatric solutions consultant at Vermont-based PCC, gives a note of caution regarding 99484 and all the other new BHI codes: "CPT^® guidance clearly states that these services are provided for a 'diagnosed psychiatric disorder,'" Blanchard says. "So, be clear about exactly what that means to your carriers and contact them for a list of specific ICD-10-CM diagnosis codes to discoverwhether they restrict the diagnoses for which they will pay."