Assessment of Psychosocial Needs
Assessing and following up on psychosocial problems takes more time than screening; as a result, payment becomes more of an issue. In 2002, new Health and Behavior Assessment and Intervention (H/B) codes were incorporated into the CPT coding set generally used by all ambulatory health care providers when submitting a claim for reimbursement.6 At the time, these codes were described as a “paradigm shift” (Foxhall, 2000) because they allowed direct billing—by nonphysicians such as clinical psychologists—for psychosocial services for general medical illnesses such as diabetes or heart disease as opposed to mental illnesses. The new codes were intended to allow behavioral health specialists to address psychological, behavioral, emotional, cognitive, and social problems interfering with patients’ ability to manage their physical illnesses. Prior to the new codes, the only way to deliver such services was to submit a bill for a mental health intervention, which required a diagnosis of mental illness.
Of note, when the American Psychological Association put forth its proposal for the adoption of these codes, the following pediatric oncology case study was used as one example of the range of interventions the codes were intended to capture:
A 5-year-old boy undergoing treatment for acute lymphoblastic leukemia is referred for assessment of pain and severe behavioral distress and combativeness associated with repeated lumbar punctures and intrathecal chemotherapy administration. Previously unsuccessful approaches had included pharmacologic treatment of anxiety (Ativan), conscious sedation using Versed, and finally, chlorohydrate, which only exacerbated the child’s distress as a result of partial sedation. General anesthesia was ruled out because the child’s asthma increased respiratory risk to unacceptable levels.
Intervention: The patient was assessed using standard questionnaires (e.g., the Information-Seeking scale, Pediatric Pain Questionnaire, Coping Strategies Inventory), which, in view of the child’s age, were administered in a structured format. The medical staff and child’s parents were also interviewed. On the day of a scheduled medical procedure, the child completed a self-report distress questionnaire. Behavioral observations were also made during the procedure using the CAMPIS-R, a structured observation scale that quantifies child, parent, and medical staff behavior.7
As defined in the 2007 CPT coding manual (Beebe et al., 2006:410–411),
6Reimbursement generally does not take place without a code to describe accurately the service delivered.
7Personal communication, Diane Pedulla, JD, American Psychological Association, January 5, 2007.