Treat Psychosocial Factors without Buying an Unwarranted Psych Claim

 

Cognitive behavioral therapy is NOT the same as psychotherapy.  It is short-term, goal-oriented and requires the injured worker to actively engage in the process, including doing homework. And it does not incur the expense of psychotherapy.

The reimbursement for CBT is a concern we frequently hear from workers’ compensation payers. Because of changes to medical billing codes, there are now descriptions that cover assessments and interventions for behavioral, social, and psychophysiological procedures for the prevention, treatment or management of physical health problems. That means that injured workers being treated for a physical condition can reap the benefits of CBT without putting the payer through the hassle and expense of an unwarranted psych claim.

Billing Codes

Current Procedural Terminology or CPT are codes published and maintained by the American Medical Association. Along with the International Classification of Diseases (ICD), they are used by all healthcare providers, payers and facilities.  

CPT and ICD coding is similar; however CPT codes identify the services rendered while ICD codes pertain to diagnoses. CPT codes describe tests, surgeries, evaluations and other procedures performed by a healthcare provider and are used by insurers to help determine reimbursement amounts.

CPT Changes

In the early 2000s, new codes were added for health and behavior assessment and intervention, instead of psych evaluation and treatment. These new codes came as good news for injured workers and payers as they allowed for effective interventions for psychosocial issues without the psychiatric diagnosis. They ensured the injured worker would not become further ‘medicalized.’

In addition to the stigma attached to a psych diagnosis, many workers’ compensation policies won’t cover a mental health condition unless it is specifically caused by work or, in some states, clearly stems from a workplace injury. Proving a causal link can be complicated and time consuming, and the resulting costs can be prohibitive for some payers.

The six new health and behavior CPT codes relate to services performed to address difficulties associated with an acute or chronic illness, prevention of a physical illness or disability and maintain health, and do not meet criteria for a psychiatric diagnosis. They are codes 96150 – 96155.

The assessment codes — 96150 and 96151 are used to determine the biopsychosocial factors that are affecting the injured worker’s medical condition and any treatment problems. The remaining intervention codes are used to provide services to improve a patient’s health and well-being using cognitive, behavioral, social and/or psychological interventions that have been shown to improve specific disease-related problems. The codes Ascellus Group predominantly uses are 96150, 96151 and 96152, as the remaining codes apply to groups or families.

The health and behavior codes are not allowed for psychotherapy services that address an injured worker’s mental health diagnosis. Also, they cannot be billed on the same day as a psychiatric CPT code.

Contrary to what some believe, the health and behavior codes are reimbursable only when they are performed by a licensed non-physician behavioral health provider — not a medical doctor. They are services to be performed by providers, generally psychologists, who are specifically trained in this area. The psychologist works in conjunction with the treating physician.

In addition to having an underlying physical injury or illness, services are allowed under the health and behavior codes if there is reason to believe that a biopsychosocial factor may be significantly affecting the treatment, or medical management of the injured worker’s condition; and the injured worker is alert, oriented and has the capacity to understand and respond meaningfully during face-to-face encounters.

CBT

Under the health and behavior codes, we use CBT in tandem with the treating physician’s medical management therapies. We help the injured worker learn cognitive (the way we think) and behavioral (actions we take) therapies to retrain the brain to act the way it did before there was chronic pain. The injured worker learns to cope with his pain and take back control of his life.

CBT is a collaborative effort between the therapist and injured worker. It is structured and directive, based on an educational model, and premised on stoic philosophy.

Conclusion

The assessment of the injured worker may include a health-focused clinical interview, behavioral observations, psychophysiological monitoring, use of health-oriented questionnaires, and assessment data interpretation. Elements of an intervention may include cognitive, behavioral, social, and psychophysiological procedures that are designed to improve the patient’s health, ameliorate specific disease-related problems, and improve overall well-being. Before the new CPT codes were established, there were none available to cover these services.

Ascellus – Integrated Medical Case Solutions – is the premier behavioral medicine network for pain and trauma response with evidence-based outcomes and a proven track record for transforming workers’ compensation cases. Ascellus makes intervention efficient with a national network of 1,500+ psychologists and psychiatrists in all 50 states.