Psychologists Working With Patients Who Have Physical Health Problems Can Benefit from Using the New CPT Health and Behavior Codes
Cheryl L. Shigaki, Ph.D.
Psychologists in both inpatient and outpatient settings who work with individuals with disability and chronic illness have the potential to benefit by using the new CPT Health and Behavior (H&B) codes. The H&B codes, which took effect in January, 2002, represent a formal step toward recognition of the broad role of psychology in health care (see links below for full listing of codes and descriptors).
Without a doubt, our greatest gain in having these codes to use is the ability to bill for services using a physical health diagnosis. The provider can see a patient for assessment and treatment of rehabilitation, disability, or illness issues even if there is no clear evidence of a mood disturbance or cognitive disorder. This can be viewed as a victory, especially for the disability community.
I work in a geriatric rehabilitation inpatient setting. In one case*, the team asked me to see a patient with debilitation from extended illness, who was agitated and refusing to cooperate in therapies. While she could speak, she had had Alzheimer’s dementia and related cognitive issues that affected her ability to express her needs. After assessing the situation, I made a recommendation that she be evaluated for constipation. This indeed was the problem and once it was treated, the patient’s behavior returned to baseline. I billed one 15-minute unit of 96150 (H&B Initial Assessment) code, with the ICD-9 diagnosis code of 331.0 (Alzheimer’s disease) and the patient was back in therapies by the afternoon.
From time to time I am asked by the team to assess and follow-up on patient tearfulness and related inability to put 100% effort into therapy. On several occasions, the situation turned out to be related to social issues (e.g. death in the family that day), and did not warrant a mental health diagnosis. Psychological intervention can be helpful with patients who have trouble engaging in rehabilitation therapies due to pain, or fear of falling, but who do not meet the criteria for depression or anxiety disorders. A psychologist also can bill for participation in psycho-educational group therapy on the basis of the medical diagnosis (brain injury, stroke, SCI) rather than depression, allowing more patients to attend.
In the outpatient setting, a child with a disability who has been teased by her peers may not want to wear some type of device or perform a necessary health care routine while at school. This type of situation could be handled using H&B codes as well. Thus, psychologists can avoid over- pathologizing patients with physical disorders, who should not be given mental health diagnoses, but who would benefit from psychological services.