星空入口

Here鈥檚 what you need to know about providing, keeping track of, and billing for the service.

Since it was introduced in 2018, the behavioral health integration (BHI) 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, per calendar month 鈥�) has been a source of confusion for many primary care providers (PCPs). Not only are the services described by the code numerous and potentially difficult to track, but issues of billing and responsibility for the services can potentially create obstacles to implementing successful BHI programs in many practices.

But a successful BHI program isn鈥檛 just good business for a primary care practice. Of course, it does increase revenue through billing for 鈥渉igher complexity visits to manage their condition that were needed by patients who received a behavioral health diagnosis鈥� and 鈥渋ncreased frequency of patient encounters.鈥� But 鈥渋t also improves 鈥減atient outcomes when care was integrated into the primary care setting,鈥� according to the American Medical Association (AMA) ().

So, whether you鈥檙e introducing a new BHI program for your practice, or figuring out how to adapt an existing one, here are the answers you need to implement the code correctly.

What Services Does a BHI Program Provide to Its Patients?

The full descriptor for BHI code 99484 outlines the scope of services that a staff member must coordinate through your practice:

• 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; and
• continuity of care with a designated member of the care team.

Or, per CPT^庐 Assistant (Volume 28, Number 7, 2018), 鈥�99484 includes several of the core elements of the evidence-based collaborative care model described in codes 99492 (Initial psychiatric collaborative care management, first 70 minutes in the first calendar month 鈥�), 99493 (Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month 鈥�), and +99494 (Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month 鈥�).鈥� These include 鈥渢he use of validated rating scales to monitor progress, facilitation and coordination of other services as needed, and continuity of care with a designated member of the care team鈥�.

Significantly, the care team does 鈥渘ot require a psychiatric consultant to be part of the 99484 model,鈥� says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

Who Is Responsible for BHI Reporting?

One of the big problems with BHI programs is 鈥渨ho documents? Where is the documentation? Keep in mind each clinician must write his or her own note. Clinicians don鈥檛 always document in the same place around the same time for a service that is collaborative,鈥� says Suzan Hauptman, MPM, CPC, CEMC, CEDC, 星空入口Fellow, senior principal of ACE Med in Pittsburgh. And if you cannot track BHI documentation, completing claims for it becomes a nightmare.

The answer, per the American Psychiatric Association, is that 鈥渢he treating physician/Primary Care Provider (PCP) submits the claims for these services鈥� (). Or, as the guidelines preceding code 99484 in CPT^庐 put it, BHI services 鈥渁re reported by the supervising physician or other qualified health care professional. 鈥� The reporting professional must be able to perform the evaluation and management (E/M) services of an initiating visit.鈥�

So, whether you鈥檙e introducing a new BHI program for your practice, or figuring out how to adapt an existing one, here are the answers you need to implement the code correctly.

What Services Does a BHI Program Provide to Its Patients?

The full descriptor for BHI code 99484 outlines the scope of services that a staff member must coordinate through your practice:

• 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; and
• continuity of care with a designated member of the care team.

Or, per CPT^庐 Assistant (Volume 28, Number 7, 2018), 鈥�99484 includes several of the core elements of the evidence-based collaborative care model described in codes 99492 (Initial psychiatric collaborative care management, first 70 minutes in the first calendar month 鈥�), 99493 (Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month 鈥�), and +99494 (Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month 鈥�).鈥� These include 鈥渢he use of validated rating scales to monitor progress, facilitation and coordination of other services as needed, and continuity of care with a designated member of the care team鈥�.

Significantly, the care team does 鈥渘ot require a psychiatric consultant to be part of the 99484 model,鈥� says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

Who Is Responsible for BHI Reporting?

One of the big problems with BHI programs is 鈥渨ho documents? Where is the documentation? Keep in mind each clinician must write his or her own note. Clinicians don鈥檛 always document in the same place around the same time for a service that is collaborative,鈥� says Suzan Hauptman, MPM, CPC, CEMC, CEDC, 星空入口Fellow, senior principal of ACE Med in Pittsburgh. And if you cannot track BHI documentation, completing claims for it becomes a nightmare.

The answer, per the American Psychiatric Association, is that 鈥渢he treating physician/Primary Care Provider (PCP) submits the claims for these services鈥� (). Or, as the guidelines preceding code 99484 in CPT^庐 put it, BHI services 鈥渁re reported by the supervising physician or other qualified health care professional. 鈥� The reporting professional must be able to perform the evaluation and management (E/M) services of an initiating visit.鈥�

So, 鈥減ractices should, or need to, set up systems to ensure the required elements of the code are met each month for which the code is billed and to track the necessary time,鈥� according to Moore. It also means coders should be involved in planning those systems 鈥渟o they have confidence that all elements have been met when reporting code(s) for a given month,鈥� Moore believes.

In other words, your practice should set up a 鈥淏HI workflow鈥� along the lines recommended by the AMA. That workflow will depend 鈥渙n the practice size, patient population, current staff capabilities, technology, and resources, etc.,鈥� and 鈥渕ay look and feel different鈥� from another organization鈥檚 per the AMA (See for more information).

Who Can Provide BHI Services?

As the descriptor for 99484 implies, the service is primarily performed by clinical staff under the direction of a physician or other qualified health care professional (QHP), and as the guidelines preceding 99484 in CPT^庐 state, BHI 鈥渃linical staff are not required to have qualifications that would permit them to separately report services (eg, psychotherapy).鈥�

Thus, clinical staff who 鈥渄o not have the same level of formal education or specialized training in behavioral health typically associated with behavioral health care managers can administer BHI鈥� says Moore. These clinical staff can include medical assistants, licensed practical nurses (LPNs), registered nurses (RNs), and others depending on the scope of practice as defined by state law, providing they are operating under the direction of a physician or other QHP per the code descriptor.

What Should I Know About Time?

Importantly, 鈥渢he time threshold is lower than those associated with psychiatric collaborative care management (99492-+99494), and the time associated with the code is open-ended; i.e., there is no time-based add-on code available with 99484,鈥� Moore notes.

As the threshold for 99484 only rises to 20 minutes of clinical staff time per calendar month, CPT^庐 Assistant suggests that the code 鈥渕ay be reported in lieu of codes 99492-+99494 in those months in which care-management time fails to meet the established thresholds of codes 99492-+99494 but meets at least 20 minutes of time during the calendar month.鈥�