Wiki Health & Behavior Assessment & Intervention Codes (96150-96154)

SheriWall83

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Good morning,
I was hoping to gain some insight on the Health and Behavior Assessment codes. I work for an LPC & LCSW who use these codes to establish treatment plans for patients to reach health goals. From what I understand, these codes are codes that should only be used temporarily, such as when a PCP diagnoses a patient with type 2 diabetes, they would refer to us for intervention on examining behaviors that contribute to these chronic illnesses. I know the patient cannot have mental health diagnoses, but I also know that mental health diagnoses contribute to a vast majority of chronic illnesses (binge eating disorder, depression, etc.)

The clinicians I work for are determined to use these codes to develop treatment plans (usually around 3 months) to administer interventions such as nutrition counseling, teaching cognitive-behavioral techniques, relaxation, coping and special skills, etc...

Anthem is denying the vast majority of these claims and from what I understand (I am in the process of getting my certification and have a little less than a year coding and billing experience) these codes were established as part of a much bigger treatment plan established by the patient's M.D. and an LPC and/or LCSW would not establish a treatment plan using these codes... thoughts?
 
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