Wiki Health and behavior assessment codes (96152-96154)

ErinPDX85

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Hello,

I am having a hard time figuring out the correct way to bill these codes. Per the definition, they must used to "bill for services provided to patients who are not diagnosed with a psychiatric problem, but whose cognitive, emotional, social, or behavioral functioning affect prevention, treatment, or management of a physical health problem."

An example given to me was a person who has stomach aches due to their anxiety. I found a resource online from Optum360 that gives a list of diagnostic codes to use with these CPT codes, but they do not make sense to me. I was hoping for some insight from my fellow coders. How do these codes fit under a physical health problem? I do understand that they could have physical health problems due to these issues, but as a standalone issue?

Z59.7 Insufficient social insurance and welfare support
Z60.0 Problems of adjustment to life-cycle transition
Z60.2 Problems related to living alone
Z62.29 Other upbringing away from parents
Z62.891 Sibling rivalry
Z63.0 Problems in relationship with in-laws
Z63.8 Other specified problems related to primary support group
Z64.4 Discord with counselors

Plus many more that fall along those lines.

Thank you!
Erin
 
I might be reading it differently, but what I see is: they can't manage their physical symptoms because of the issue represented by the Z code. Someone in extreme poverty (Z59.5) can't manage their diabetes adequately because of the cost of meds, food insecurity, and lack of access to specialty care. It's something that affects their physical health, but itself isn't a health problem--that is, an issue contained within or on the body.
 
Thank you & I completely agree with you. But, I feel we cannot use those codes unless there is an actual physical health symptom present at the time of service. That's where my confusion lies.
 
Dx codes with MH Illness

Hello,

I am having a hard time figuring out the correct way to bill these codes. Per the definition, they must used to "bill for services provided to patients who are not diagnosed with a psychiatric problem, but whose cognitive, emotional, social, or behavioral functioning affect prevention, treatment, or management of a physical health problem."

An example given to me was a person who has stomach aches due to their anxiety. I found a resource online from Optum360 that gives a list of diagnostic codes to use with these CPT codes, but they do not make sense to me. I was hoping for some insight from my fellow coders. How do these codes fit under a physical health problem? I do understand that they could have physical health problems due to these issues, but as a standalone issue?

Z59.7 Insufficient social insurance and welfare support
Z60.0 Problems of adjustment to life-cycle transition
Z60.2 Problems related to living alone
Z62.29 Other upbringing away from parents
Z62.891 Sibling rivalry
Z63.0 Problems in relationship with in-laws
Z63.8 Other specified problems related to primary support group
Z64.4 Discord with counselors

Plus many more that fall along those lines.

Thank you!
Erin

Hi Erin
I would address the MH condition in conjunction why the patient arrived at your door...paranoia,Alzheimer,ulcers, depression etc. then if the patient had cold, or stomach problem, add this dx code too, but then add the Z dx code corresponding to psych problem last. All must be documented in the record of course and addressed by the doctor or psychiatrist. What was the main reason came and then additional dx. codes?
I hope this helps
Lady T
PS Some dx codes are first listed Z dx codes and some Z dx codes are not. just saying and your IDC10 manual list these differ Z dx codes too
 
Thank you for your reply. Patients are coming in for a variety of reasons or it is their annual physical. Your suggestion is what we are trying to do. Hard in certain situations where the patient really is just depressed and there is nothing physically wrong. But a quick 10 minute chat with our MH provider can sometimes help, unfortunately this service does not fit the criteria of these codes. Maybe someday they'll have a quick consultation CPT code.

Thanks!
Erin
 
Hello,

The Health and Behavior Assessment Intervention (HBAI) codes are meant for non-physicians who see patients with psychological diagnoses caused by physical conditions. For example, patient comes in for depression because he/she has cancer/diabetes/morbid obesity/severe COPD/etc.

If there is no direct link with the psychological manifestation and the physical condition, then HBAI codes are probably not appropriate. I did a lot of research on these codes last year (new provider trying to bill these codes as an Integrated Behaviorist), so I had to figure out the rules behind HBAI).

Does this help? - if the visit doesn't qualify for HBAI (due to lack of the underlying physical condition), then perhaps another Psych code might be appropriate?
 
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