HEALTH AND BEHAVIORAL CODES

Health and Behavioral assessment codes identify the psychological, behavioral, emotional, cognitive, and social factors significant to prevention, treatment, or management of a Resident's physical illness. The primary focus of the assessment is on the biopsychosocial factors important to physical health and treatment of the Resident.

In 1999 the American Psychological Association (APA) introduced the Health and Behavior assessment codes to the American Medical Association (AMA), which makes recommendation to the Centers for Medicare and Medicaid Services (CMS) for new or revised CPT Editorial Panel, which revises, updates, and modifies CPT codes. The CPT Editorial Panel approved the Health and Behavioral assessment codes and forwarded them to the AMA Health Care Professional Advisory Committee (HCPAC) to establish relative value units (also known as work value) and practice expense values.

In November 2000 NASW, with the assistance of the Clinical Social Work Federation (CSWF), surveyed a random sample of clinical social workers in private practice to help determine the relative value units and practice expense values for the new codes. The survey instrument was designed and provided by the American Medical Association (AMA). In addition, clinical social workers from NASW, CSWF, and the Clinical Social Work Institute of Washington, DC, were invited to participate on two survey panels.

The results of the Health and Behavior assessment survey from the clinical social workers were combined with survey results from APA, which had surveyed their clinical psychologists with the same AMA instrument. In February and April of 2001, NASW and APA made joint presentations to the AMA/HCPAC approved the values for the codes and forwarded the codes to CMS for final approval. The final relative value units and practice expense values were published in the November 1, 2001, issue of the Federal Register.

The health and behavior assessment codes identify services to patients who do not have a diagnosed mental illness and present with an established physical illness or symptoms. The assessment focuses on the biopsychosocial factors related to the patient’s physical health condition(s). The assessment includes evaluation of items such as the patient’s adherence to medical treatment, health-related risk-taking behavior, and adjustment to their medical illness. It may also include a health-focused clinical interview, behavioral observations, psychophsyiological monitoring, use of health-oriented questionnaires, and data interpretation. Elements of a Health and Behavior interview “may include cognitive, behavioral, social, and psychophsyiological procedures that are designed to improve the patient’s physical health and well-being.”

The Health and Behavior assessment codes differ from the usual psychiatric CPT codes in that mental health is not a major focus of the services provided. The usual psychiatric codes require a mental health diagnosis and identify services for a psychiatric evaluation and psychotherapy. Problems associated with an acute or chronic illness, prevention of a physical illness or disability, and maintenance of health usually do not meet the criteria for a mental health diagnosis. Use of the Health and Behavioral assessment codes prevents inappropriate labeling of a patient as having a mental health disorder when the problem may be related to a physical illness e.g., depression associated with a patients diabetes or anxiety associated with a patients congestive heart failure.