Medical Coding for Psychiatric Collaborative Care Services (CoCM)

September 17, 2019Behavioral Health

Collaborative Care Services (CoCM)

Integrating behavioral health care with primary care (“behavioral health integration” or “BHI”) is an effective strategy for improving outcomes for the millions of Americans with mental or behavioral health conditions. As of January 1, 2018, these services will be reported using new CPT codes. CPT codes 99492, 99493, and 99494 are used to bill for monthly services furnished using the Psychiatric Collaborative Care Model (CoCM), an approach to BHI shown to improve outcomes in multiple studies.

As of January 1, 2017, Medicare makes separate payments to physicians and non-physician practitioners for BHI services they furnish to beneficiaries over a calendar month service period. This figure is a model of behavioral health integration that enhances “usual” primary care by adding two key services to the primary care team, particularly regarding patients whose conditions are not improving:

• Care management support for patients receiving behavioral health treatment
• Regular psychiatric inter-specialty consultation
• A team of three individuals provides CoCM: the Behavioral Health Care Manager, the Psychiatric Consultant and the Treating (Billing) Practitioner

GENERAL BHI

CPT code 99484 is used to bill monthly services furnished using BHI models of care other than Collaborative Care Services (CoCM) that similarly include “core” service elements such as systematic assessment and monitoring, care plan revision for patients whose condition is not improving adequately, and a continuous relationship with a designated care team member. CPT code 99484 may be used to report models of care that do not involve a psychiatric consultant, nor a designated behavioral health care manager (although such personnel may furnish General BHI services). CMS expects to refine this code over time, as more information becomes available regarding other BHI care models in use.

BHI Coding Summary

CPT Codes Description

99492 CPT Code

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, with the following required elements:

• Outreach to and engagement in treatment of a patient-directed by the treating physician or other qualified health care professional
• Initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan
• Review by the psychiatric consultant with modifications of the plan if recommended
• Entering patient in a registry and tracking patient follow-up and progress using the registry, with appropriate documentation, and participation in weekly caseload consultation with the psychiatric consultant
• Provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies

99493 CPT Code

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, with the following required elements:

• Tracking patient follow-up and progress using the registry, with appropriate documentation
• Participation in weekly caseload consultation with the psychiatric consultant
• On-going collaboration with and coordination of the patient’s mental health care with the treating physician or other qualified health care professional and any other treating mental health providers
• Additional review of progress and recommendations for changes in treatment, as indicated, including
• medications, based on recommendations provided by the psychiatric consultant
• Provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies
• Monitoring of patient outcomes using validated rating scales; and relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment

99494 CPT Code

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)

99484 CPT Code

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 time, per calendar month, with the following required elements:

• Initial assessment or follow-up monitoring, including the use of applicable validated rating scales
• Behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes
• Facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation
• Continuity of care with a designated member of the care team

CPT © Copyright 2021 American Medical Association

Medical coding for behavioral health is challenging as compared to other medical specialty coding. These new CPT codes for CoCM completely change the way you code your mental health services. Outsourcing your medical coding could be a good option as you can dedicatedly focus on your core practice responsibilities only. To know more about mental health coding and billing services provided by E2E Medical Billing Services, you can call us at 888-552-1290 or write to us at info@e2eMedicalBilling.com