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2. Pamela Ballou-Nelson, RN, MSPH, PhD
Coding and Documenting Behavioral Health
Pamela Ballou-Nelson, RN, MSPH, PhD
Principal Consultant
MGMA Health Care Consulting Group
And
Jill Atkinson, Ph.D. Community Reach Center
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3. Objectives Coding Behavioral Health for Colorado Medicaid
Coding Integrated Behavioral Health
Documenting for Integrated Behavioral Health
BH and Commercial Plans
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4. Copyright 2017. Medical Group Management Association® (MGMA®)
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5. Coding for integrated behavioral health and other psychotherapy services
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6. Behavioral Health Integration
Integrating behavioral healthcare with primary care is now widely considered an effective strategy for improving outcomes for the many millions of Americans with mental or behavioral health conditions.
New England Journal of Medicine, Perspective
February 2, 2017
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7. Breaking the Barriers
Previously, not separately reimbursable, leaving practices without a clear business model for incorporating these services into their practice.
Schwenk TL. Integrated behavioral and primary care: what is the real cost? JAMA2016; 316:
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8. Integrated Mental Health Services Billing for Medicaid Jill Atkinson, Ph.D. Community Reach Center

9. Behavioral Health billing for Integrated Care for Medicaid Patients
Behavioral Health billing goes through a Behavioral Health Organization (BHO)
You must have a contract with your BHO to bill behavioral health services
You will get a fee for service contract
Be sure the FFS contract includes H codes, as these are the most commonly used codes for screening and short interventions
This will change once the RAE’s are in effect

10. Two strategies for billing behavioral health
Level 1: CPT codes that are numeric and have 5 digits.
Traditional mental health services – must have a mental health “covered” diagnosis and must meet minimum documentation requirements for the code.
Service requires at least a Master’s Degree and a formal assessment that leads to the diagnosis.
After 6 visits must do a CCAR, and must have a signed treatment plan.
Level II: standardized coding system for services not included in the CPT codes. The codes are alpha numeric. For this presentation we will review the H codes.
Integrated behavioral health approach: will rely on H codes. Most H codes either do not require a mental health diagnosis or exclude a mental health diagnosis.

11. H Codes Code Description Dx Required Example H0002
Behavioral health screening to determine eligibility for admission to program
No Dx required. If no dx then use list as:
Unspecified illness – R69
Encounter for observation for other unspecified diseases ruled out–Z03.89
PHQ-9
ASQ (for kids)
H0023
Behavioral health outreach service
No dx required
Need to use R69, Z03.89 or unspecified F code
Phone or in person contact designed to engage patient in services

12. Code Description Dx Required Example H0025
Behavioral health prevention education service (delivery of services to affect knowledge, attitude and/or behavior. It may include screenings to assist individuals in obtaining appropriate treatment. Prevention activities are delivered prior to the onset of a disorder and are intended to prevent or reduce the risk of developing a behavioral health problem.
No dx required
Need to use R69, Z03.89 or unspecified F code
Parenting class, healthy living class

13. Code Description Dx Required Example H0004
Individual counseling/therapy outlined in the treatment/service plan. Problem(s) as identified by an assessment and listed in the treatment/service plan. The intended outcome is the management, reduction/resolution of the identified problem(s).
Mental Health diagnosis is required
H0004 offers flexibility in terms of time increments and POS. H0004 may include unplanned telephone contact and/or planned contact if medically necessary, clinically justified, and included in the treatment/service plan

14. Code Description Dx Required Example H2011
Unanticipated services rendered in the process of resolving a client crisis, requiring immediate attention, that without intervention, could result in the client requiring a higher LOC., Services include: immediate crisis intervention to de-escalate the individual or family in crisis, assess dangerousness of situation,
No Dx required. If no dx then use list as:
Unspecified illness – R69
Encounter for observation for other unspecified diseases ruled out–Z03.89
Face-to-face/telephone contact to provide immediate, short-term crisis-specific assessment and intervention/counseling with client and, as necessary, with client’s family members
Referral to other applicable BH services, including pre-inpatient screening;

15. Code Description Dx Needed Example H2011 (cont’d)
determine risk of suicide or danger to others, assess access to or ability to utilize support, triage, assess for and facilitate admission to higher level care or additional forms of treatment if needed to stabilize the immediate situation
activities include telephone contacts/ meeting with receiving provider staff
● Face-to-face/telephone consultation with physician/ hospital staff, regarding need for psychiatric consultation or placement
● Face-to-face/telephone contact with another provider to help that provider deal with a specific client’s crisis
● Consultation with one’s own provider staff to address the crisis

16. Things to Remember Follow minimum documentation standards.
Understand the unit for billing and the minimum amount of time needed to qualify for each one. Some codes are encounter based and some are 15 minute increments.
There are many more H codes, look them over and see if you qualify to use any of them and have them added to your contract.
Consider the implications of diagnosing and treating Substance Use Disorders.
Develop clear protocols for use of BH services.
Using H codes for any payer other than Medicaid will result in a denial and possibly a charge to the patient.

17. Resources
Coding Manual:
SBIRT/SUD Medicaid billing:

18. CMS Final Rule for 2017 Medicare Payments for Integrated Behavioral Health Services
For patients participating in a Collaborative Care Model (CoCM) Medicare has established three new codes to report integrated behavioral services
G0502
G0503
G0504
Other BHI models
G0507
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19. G0502 ~ Initial psychiatric collaborative care mgmt
G0502 ~ Initial psychiatric collaborative care mgmt., first 70 minutes in the first calendar month of behavioral healthcare manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other QHCP with the following required elements:
Outreach to and engagement in treatment of a patient directed by the treating physician or other qualified healthcare professional;
Initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan;
Review by the psychiatric consultant with modifications of the plan if recommended;
Entering patient in a registry and tracking patient follow-up and progress using the registry, with appropriate documentation, and participation in weekly caseload consultation with the psychiatric consultant; and
Provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies.
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20. G0503 ~ Subsequent psychiatric collaborative care mgmt
G0503 ~ Subsequent psychiatric collaborative care mgmt., first 60 minutes in a subsequent month of behavioral healthcare manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other QHCP with the following required elements:
Tracking patient follow-up and progress using the registry, with appropriate documentation;
Participation in weekly caseload consultation with the psychiatric consultant;
Ongoing collaboration with and coordination of the patient’s mental healthcare with the treating physician or other qualified healthcare professional and any other treating mental health providers;
Additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant;
Provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies;
Monitoring of patient outcomes using validated rating scales; and relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment.
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21. G0504 ~ Initial or Subsequent psychiatric collaborative care mgmt
G0504 ~ Initial or Subsequent psychiatric collaborative care mgmt., each additional 30 minutes in a calendar month of behavioral healthcare manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other QHCP.
List separately in addition to code for primary procedure. (Use G0504 in conjunction with G0502 & G0503)
G0507 ~ Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified healthcare professional time, per calendar month.
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22. 2017 National Fee Schedule Non-facility rate G0502 $142.84
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23. n engl j med 376;5 nejm.org February 2, 2017
Widespread implementation of CoCM and other effective BHI services could substantially improve outcomes for millions of Medicare beneficiaries and produce savings for the Medicare program.
n engl j med 376;5 nejm.org February 2, 2017
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24. Psychotherapy with Evaluation & Management/Same Day
Psychotherapy, 30 minutes with patient when performed with an E&M service
Psychotherapy, 45 minutes with patient when performed with an E&M service
Psychotherapy, 60 minutes with patient when performed with an E&M service
List in addition to appropriate level of E&M service
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25. Commercial Payers
Know your contracts to see if BH is covered, in what manner, which product lines and which codes.
The codes trigger any insurance company to act. They are covered or not covered; the plan dictates the coverage.
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26. Documentation
Structured care plans. Clinicians create and maintain a care plan that outlines treatment, describes plans for follow-up, and ensures that the patient and all involved clinicians are on the same page.
The plan provides access to patient information and identifies who’s responsible for addressing specific healthcare needs and goals.
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27. Documentation
Benefits of Using the EHR for Behavioral Health Providers:
See what other providers see
Participate more closely in care
Ability to use note templates
Allows use of Consult Tracking
Allows for notes to be electronically signed
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28. Resources
PCPCI Tool Kit For BH Integration CBH%20Implementation%20Kit_FINAL.pdf AHRQ Tool Kit ure-collection/literature/primary-care-behavioral- health-toolkit
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29. Copyright 2017. Medical Group Management Association® (MGMA®)
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