Internal Medicine Coding Alert
Clarifying the New Health & Behavior Codes
Alabama Subscriber
Answer: As physicians know, psychological, behavioral, emotional, cognitive, and social factors play a major role in the prevention, treatment and/or management of physical health problems. For the treatment of many health problems, psychosocial factors often must be assessed and addressed. Prior to 2002, CPT did not provide adequate coding options for these types of interventions. The new codes are:
Preventive medicine examinations detect and prevent health problems, as does preventive medicine counseling, but these codes should be used for healthy patients. They are not for interventions in patients with symptoms or an established illness. Psychiatry codes are often used for these purposes, but require a psychiatric diagnosis. However, CPT's addition of the new health and behavior assessment codes recognizes that many of the difficulties associated with an acute or chronic illness or disability do not meet the criteria for a psychiatric diagnosis. The new codes allow a patient with a physical illness to receive psychosocial services without being labeled with a psychiatric disorder.
The new codes were added to describe psychosocial assessment and intervention for patients with established illnesses who do not have a mental-health diagnosis. The services appropriate for the new codes are psychosocial evaluations and interventions related to the patient's adherence to medical treatment, symptom management and expression, health-related risk-taking behaviors, health-promoting behaviors, and overall adjustment to medical illness.
The AMA clarified the intent of these codes at the CPT 2002 Symposium in Chicago last fall. According to our sources, these codes are intended to be used primarily by "nonphysician practitioners like psychologists, advance practice nurses, clinical social workers and others whose scope of practice includes subspecialty training in health/behavioral assessments and interventions. Physicians may also report these codes, but in some instances may prefer to use E/M codes based on counseling time."
A health and behavior assessment may include, but is not limited to, a health-focused clinical interview, behavioral observations, psychophysiological procedures, use of health-oriented questionnaires, and assessment and data interpretation. A health and behavior intervention may include cognitive, behavioral, social and psychophysiological procedures that are designed to improve the patient's health.
CPT offers the following guidelines for using these codes:
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