May 3, 2024 | By J. Paul Spencer, CPC, COC
Primary care providers are increasingly becoming gatekeepers to mental and behavioral health care. This is due partly to increased awareness in the medical field of the overall health effects brought about by mental illness, as well as the addition of CPT codes for reimbursement that incentivize assessing patients for depression.
Care for such identified individuals is not as simple as writing a referral to another physician specializing in mental health treatment. One only has to think for a moment about television commercials that pitch various mental health medications, which spend a majority of time talking about possible side effects of the drug, to understand that collaboration with a primary care provider is essential to the successful treatment of mental illness.
Let’s rewind to the beginning of the care arc for these patients. To determine a treatment course, patients with mental health issues must first be identified. CPT code 96127 is defined as a “Brief emotional/behavioral assessment (e.g., depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument.” Several screening tools fall into this category, such as PHQ-2, that qualify for the use of this code. The inclusion of the term “per standardized instrument” is not accidental. In the event of a high score on one test, the provider may decide that another, more thorough screening inventory tool is required further to identify symptoms and indicators of adverse mental health. It is essential to be aware that CPT code 96127 has a medically unlikely edit of 3, meaning that no more than three screening instruments should be used during the same encounter.
Once screening is completed and the need for further mental health care is identified, the provider will assess treatment options, including non-medicinal holistic methods, prescription drug management, or referrals for direct psychiatric care. This will depend on the care regimen most aligned with the acuity of the problem and the most desired outcome of treatment. It is here that the collaborative journey begins.
It is important to understand that most mental health conditions, once identified, typically fall into the realm of “chronic illnesses.” A limited number can be situational, such as grief from the loss of a loved one, but even these may require treatment over an extended period.
As it applies to primary care, assessing how specific treatments may affect other patient conditions being actively managed is important. This is particularly important in the event of unexpected hospitalization, where medication reconciliation, along with the introduction of drugs used to stabilize the patient, can have pronounced side effects. Depending on the severity of the identified mental illness, medications that treat other chronic illnesses may need to be titrated based on specific systemic side effects of medication.
Internal collaboration also comes into play. Suppose the psychiatric medications prescribed require intensive monitoring. In that case, the monitoring program itself will need to be carefully surveilled to ensure that the patient is being monitored on the schedule set forth by the provider. Administrative staff will need to set reminders to contact the patient for monitoring.
Mental illness in primary care does encounter certain hurdles, but attention to detail, along with a defined collaborative process specific to each patient, can help a practice clear these barriers with room to spare.
Contact:
J. Paul Spencer is a Senior Compliance Consultant with DoctorsManagement and a NAMAS Team Member. If you wish to contact Mr. Spencer regarding this article or any other help or assistance, please contact him at pspencer@drsmgmt.com
