Coexisting physical and behavioral health conditions can be difficult to manage. Studies have found that people hospitalized for physical health conditions who also have mental illness are more likely to be readmitted than people who don’t have mental illness. Proper follow-up care for behavioral health after a hospitalization is often lacking, according to the National Committee for Quality Assurance.
Behavioral health consultations during a hospital stay can help our members who have physical and behavioral health conditions. Addressing behavioral health care with timely follow-ups can help reduce hospital readmissions and improve health outcomes, according to NCQA.
We encourage hospital staff/attending providers to discuss behavioral health with our members during a hospital stay and to consider consultations and follow-up care coordination when appropriate.
Tips for Behavioral Health Consultations and Follow-up Care
To help improve outcomes for our members receiving inpatient care, we encourage hospital staff/attending providers to consider the following:
- Discuss with our members and their medical teams how medical and behavioral health diagnoses are important and can be intertwined.
- Facilitate behavioral health consultations for our members when they’re admitted to a medical unit for a medical concern and also exhibiting behavioral health symptoms.
- Coordinate care with our members’ medical and behavioral health providers and social support to help ensure timely follow-ups. A behavioral health follow-up within 30 days after discharge can be in the form of:
− Behavioral health inpatient admission
− Partial hospitalization program
− Intensive outpatient program
− Behavioral health outpatient appointment
Coding for Behavioral Health Consultations
When a member receives a psychiatric consultation while medically inpatient and receives a secondary behavioral health diagnosis, include the following on claims:
- The behavioral health diagnosis
- The correct Current Procedural Terminology (CPT®) codes for a psychiatric consult
Below is information from the American Medical Association about coding for behavioral health consultations (pages 24 and 28). Total time for reporting these services includes face-to-face and non-face-to-face time personally spent by the physician or other qualified health care professional on the date of the encounter.
| CPT code | Threshold Time | Description |
|---|---|---|
| 99221 | At least 40 minutes of total time on the date of the encounter | Initial hospital inpatient or observation care, per day, for the evaluation/management of a patient, which requires a medically appropriate history and/or examination and straightforward or low-level medical decision making |
| 99222 | At least 55 minutes of total time on the date of the encounter | Initial hospital inpatient or observation care, per day, for the E/M of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making |
| 99223 | At least 75 minutes of total time on the date of the encounter | Initial hospital inpatient or observation care, per day, for the E/M of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making |
| 99231 | At least 25 minutes of total time on the date of the encounter | Subsequent hospital inpatient or observation care, per day, for the E/M of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making |
| 99232 | At least 35 minutes of total time on the encounter on a single date | Subsequent hospital inpatient or observation care, per day, for the E/M of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making |
| 99233 | At least 50 minutes of total time on the date of the encounter | Subsequent hospital inpatient or observation care, per day, for the E/M of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making |
The material presented here is for informational/educational purposes only, is not intended to be medical advice or a definitive source for coding claims and is not a substitute for the independent medical judgment of a physician or other health care provider. Health care providers are encouraged to exercise their own independent medical judgment based upon their evaluation of their patients’ conditions and all available information, and to submit claims using the most appropriate code(s) based upon the medical record documentation and coding guidelines and reference materials. References to other third-party sources or organizations are not a representation, warranty or endorsement of such organization. The fact that a service or treatment is described in this material, is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.
CPT copyright 2023 American Medical Association. All rights reserved. CPT is a registered trademark of the AMA.