Primary Care Mental Health for Veterans: Integrating Care October - PowerPoint PPT Presentation

Primary Care Mental Health for Veterans: Integrating Care October 25, 2017

Integrated Care Mental Health Specialty Care On site, embedded in the primary care clinic A different floor, a different building Location Most are healthy, mild to moderate symptoms, Most have mental health diagnoses, Population behaviorally influenced problems. including serious mental illness Collaborative & on-going consultations via PCP’s method Consult requests, chart notes, Focus within Provider of choice (phone, note, conversation). mental health treatment team. Communication Brief (20-40min) visits, limited number of encounters, Comprehensive evaluation and treatment, Service offer telephone follow-up 1 hour visits, scheduled in advance. Delivery Structure Problem-focused, first line psychopharmacotherapy, Diagnostic assessment, psychotherapy and Approach solution-oriented, functional assessment. Focused on advanced psychopharmacotherapy, PCP question/concern and enhancing PCP care plan. individual and group, recovery-oriented Population health model. care. Broad scope that varies by diagnosis.

CPT/ 2016 Description Provider approved** HCPCS wRVU Assessment MD, DO, CNS, ANP, PA, CP, 90791 Psychiatric diagnostic evaluation 3.00 SW, LPMHC, MFT 90792 Psychiatric diagnostic evaluation with medical services 3.25 MD, DO, CNS, ANP, PA H0001 Alcohol and/or Drug Assessment 0.5* All within scope of practice Individual Psychotherapy Psychotherapy face-to-face with patient and/or family member.; MD, DO, CNS, ANP, PA, CP, 16-37 minutes 90832 1.50 SW, LPMHC, MFT *Psychotherapy face-to-face with patient and/or family member. MD, DO, CNS, ANP, PA, CP, 38-52 minutes 90834 2.00 SW, LPMHC, MFT Individual Psychotherapy with E&M Psychotherapy face-to-face with patient and/or family member.; 16-37 minutes First code Evaluation & Management (E&M) +90833 1.50 MD, DO, CNS, ANP, PA service. Psychotherapy face-to-face with patient and/or family member.; 38-52 minutes First code E&M service. +90836 1.90 MD, DO, CNS, ANP, PA Crisis Intervention Codes Psychotherapy for crisis first 60 minutes MD, DO, CNS, ANP, PA 90839 3.13 CP, SW, LPMHC, MFT Psychotherapy for crisis; use in conjunction with 90839 for each MD, DO, CNS, ANP, PA +90840 1.5 additional 30 minutes after 60 minutes CP, SW, LPMHC, MFT Crisis intervention service, per 15 minutes MD, DO, CNS, ANP, PA H2011 0.5 CP, SW, LPMHC, MFT Crisis Intervention, per hour MD, DO, CNS, ANP, PA S9484 0.5 CP, SW, LPMHC, MFT

Outpatient Prolonged Service Codes Prolonged service in the office or other outpatient setting requiring direct patient MD, DO, CNS, ANP, PA contact beyond the usual service, first hour CP, SW, LPMHC, MFT +99354 1.77 Outpatient prolonged service; use in conjunction with +99354 for each additional MD, DO, CNS, ANP, PA 30 minutes CP, SW, LPMHC, MFT +99355 1.77 Inpatient Prolonged Service Codes Prolonged service in the inpatient or observation setting requiring unit/floor time MD, DO, CNS, ANP, PA with direct face-to-face patient contact beyond the usual service, first hour CP, SW, LPMHC, MFT +99356 1.71 Inpatient prolonged service; use in conjunction with +99356 for each additional 30 MD, DO, CNS, ANP, PA minutes CP, SW, LPMHC, MFT +99357 1.71 Group Psychotherapy and Interventions Group psychotherapy other than of a multifamily group. MD, DO, CNS, ANP, PA CP, SW, LPMHC, MFT 90853 0.59 Family Services Family psychotherapy (without the patient present) MD, DO, CNS, ANP, PA CP, SW, LPMHC, MFT 90846 2.4 Family psychotherapy ( conjoint psychotherapy with patient present) MD, DO, CNS, ANP, PA CP, SW, LPMHC, MFT 90847 2.5 Multiple Family psychotherapy MD, DO, CNS, ANP, PA CP, SW, LPMHC, MFT 90849 .59 Consultation with Family. Family Feedback/Education. Explanation of results of All within scope of practice examination, procedures, data, to family or other responsible person. 90887 1.48

Health and Behavior (Family) Education H/B Family (with the patient present) intervention (e.g. stress All within scope of practice management/coping strategies), each 15 min 96154 .45 H/B Family (without the patient present) intervention (e.g. stress All within scope of practice management/coping strategies), each 15 min 96155 .44 Family with Veteran, psychoeducational service. Activities to provide All within scope of practice information and education to clients, families, and significant others regarding mental disorders and their treatment. Each 15 minutes. .5* H2027 Health and Behavior (Individual) Education Initial H/B assessment (e.g. Health-focused clinical interview, MD, DO, CNS, ANP, PA, CP, SW, behavioral observations, psychophysiological monitoring, health- LPMHC, MFT oriented questionnaires), each 15 minutes face-to-face with the .5 patient; initial assessment 96150 Assessment, health and behavior subsequent (per 15 minutes) MD, DO, CNS, ANP, PA, CP, SW, LPMHC, MFT 96151 .48 Intervention, health and behavior, individual (per 15 minutes) MD, DO, CNS, ANP, PA, CP, SW, LPMHC, MFT 96152 .46

Health and Behavior (Group) Education H/B Group (2 + patients) intervention (e.g. stress management/coping All within scope of practice strategies), each 15 min 96153 0.1 Self-Management education and training (2-4 patients) with All non-prescriptive within standardized curriculum. May include caregiver/family. Each 30 scope of practice minutes 98961 0 Self-Management education and training (5-8 patients) with All non-prescriptive within standardized curriculum. May include caregiver/family. Each 30 scope of practice minutes 98962 0 Group health educational/counseling services All within scope of practice 99078 0.4* Group educational services not otherwise classified All non-prescriptive within scope of practice S9446 0.4* Weight Management Class Non-MD Per Session All within scope of practice S9449 0.2* Nutrition Classes Non-MD Per Session All within scope of practice S9452 0.2* Smoking Cessation Class Non-MD Per Session All within scope of practice S9453 0.5* Class for stress management All non-prescriptive within scope of practice S9454 0.2*

Team Conference with Veteran/Family Team conference (minimum 3 different disciplines) with participation by All non-prescriptive within qualified non-prescriptive provider, face-to-face with patient and/or scope of practice 99366 0.82 family, 30 minutes or more Team Conference without Veteran/Family Team conference (minimum 3 different disciplines) with participation by MD, DO, CNS, ANP, PA prescriptive provider. Patient and/or family not present, 30 minutes or and all others within scope of more devoted to the same patient practice 99367 1.1 Team conference (minimum 3 different disciplines) with participation by All non-prescriptive within qualified non-prescriptive provider. Patient and/or family not present, 30 scope of practice minutes or more devoted to the same patient 99368 0.72 Telephone All non-prescriptive within scope of practice 98966 5-10 minutes of medical discussion. 0.25 All non-prescriptive within scope of practice 98967 0.5 11-20 minutes of medical discussion. All non-prescriptive within scope of practice 98968 0.75 21-30 minutes of medical discussion. MD, DO, CNS, ANP, PA 99441 5-10 minutes of medical discussion. 0.25 MD, DO, CNS, ANP, PA 99442 11-20 minutes of medical discussion. 0.5 MD, DO, CNS, ANP, PA 99443 21-30 minutes of medical discussion. 0.75

Other Psychiatric evaluation of hospital records, other psychiatric reports, psychometric All within scope of practice and/or projective tests, and other accumulated data for medical diagnostic purposes. 90885 0.97 Preparation of report of patient’s psychiatric status, history, treatment, or All within scope of practice progress (other than for legal or consultative purposes) for other individuals, agencies, or insurance carriers. 90889 0.57 Self-Help/Peer Services, each 15 minutes Peer Support Specialist H0038 0.0 Behavioral health counseling and therapy, per 15 minutes All within scope of practice H0004 0.5* Alcohol and/or drug services; crisis intervention (outpatient) All within scope of practice H0007 1.2* Alcohol and/or drug services; ambulatory detoxification All within scope of practice H0014 0.95* Psychoeducational Service, per 15 minutes All Scope of Practice H2027 0.5 * These are imputed wRVU values; codes with imputed wRVU values are not billed + These are add-on codes; report in addition to the primary service **MD and DO= Physician, CNS=Clinical Nurse Specialist, ANP=Advanced Nurse Practitioner, PA=Physician Assistant, CP=Clinical/Counseling Psychologist, SW=Social Worker, LPMHC=Licensed Professional Mental Health Counselor, MFT=Marital and Family Therapist; “All within scope of practice” includes Addiction Therapists, Registered Nurses; other Therapists

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