Clinicians may have concern about how to obtain a medical diagnosis. The psychologist is not expected to establish this diagnosis; they must use a diagnosis that has been given by a physician. This is not to say, however, that a physician’s referral is necessary in order to use the codes. Such a referral is not required. However, physician contact can be helpful in order to clarify the diagnosis and ICD-9 code.
In an inpatient setting, diagnostic information may be relatively easy to obtain from the medical chart or other sources of billing information. In the outpatient setting, a diagnosis may be obvious (e.g. diabetes, amputation, traumatic brain injury, stroke) and the psychologist can use the ICD-9 (see below for link to on-line version) to find the code needed. If less obvious, the psychologist may need to obtain a release of information to contact the patient’s physician. In such a circumstance, the psychologist should ask for the specific ICD-9 diagnosis code (including any 4th and 5th digits that may apply) in addition to the verbal descriptor.
There are a few important things to bear in mind when using the H&B codes. First, billing is done in 15 minute increments. These increments reflect face-to-face time only. The codes do not allow for additional report-writing time. The H&B procedure codes may not be used with a mental health diagnosis code. They may only be used with a medically-based ICD-9 code, indicated first on the billing claim. The patient may have an Axis I disorder, but the H&B reflects treatment aimed at the physical disorder. If the mental health disorder is being treated, the regular mental health CPT codes should be used. Depending on the situation, a psychologist may appropriately bill both types of services for the same patient. In such a situation, the psychologist should be careful to document the specific problems and interventions. There is one restriction in that an H&B service and a mental health service cannot be billed on the same day.
While the rate of reimbursement varies across local carriers, Medicare is currently reimbursing for H&B services in all states but Florida. The exception, similar to existing psychotherapy codes, is the H&B “family therapy without patient” which has not been being reimbursed. In the future, APA will be increasing its tracking of reimbursement patterns by private insurers; who have not been reimbursing as frequently, but tend to follow the lead of Medicare. As of March, 2004, 7 psychologists have reported payment of H&B claims by 7 private carriers across the nation.
If independent psychologists have problems billing these codes under Medicare, the APA Practice Directorate recommends contacting the local Medicare carrier to find out what the problem is. Psychologists who work in health care facility settings may have difficulty obtaining accurate information if their billing office is unfamiliar with psychology billing practices. It may be most helpful for psychologists in these settings to contact their local fiscal intermediary or CMS regional office about billing these codes. APA wants to know about any difficulties psychologists experience in billing these codes, and any new information about private carriers. To report both payment and non-payment issues, psychologists may contact the APA Practice Directorate’s Government