Bringing Behavioral Health Into Your Practice Through a Psychiatric Collaborative Care Program
Learn how to implement an integrated behavioral health program that will more than pay for itself while increasing patients' access to care.
Fam Pract Manag. 2019 Nov-Dec;26(6):11-16.
Author disclosures: no relevant financial affiliations disclosed.
Family physicians understand that integrating behavioral health with primary care improves outcomes in both mental and physical health. More than a dozen well-designed studies support that. In January 2017, the Centers for Medicare & Medicaid Services (CMS) rolled out new payment opportunities for primary care physicians and clinicians who integrate behavioral health into their practices. The four billable procedure codes are for two different levels of behavioral health care. The more basic service is called general behavioral health integration, or BHI, and can potentially be delivered by a physician alone (see “General behavioral health integration model”). The more comprehensive service, the psychiatric collaborative care model (CoCM), requires a primary care (or other) physician or clinician to lead a team that includes a behavioral health care manager who checks in with patients at least once a month and an off-site psychiatric consultant who regularly reviews patients' progress and offers advice. This article will discuss how we implemented the CoCM model in our practice. It will also provide guidance on how you can establish a similar program to improve patients' access to behavioral health care while increasing revenue.
The psychiatric collaborative care model (CoCM) is an integrated behavioral health services program that includes a primary care physician or other clinician, a behavioral health care manager, and a psychiatric consultant.
CoCM can be billed to Medicare using procedure codes 99492, 99493, and 99494, along with the appropriate ICD-10 codes for the conditions being treated.
Patients can be referred for CoCM for any behavioral health condition the primary care clinician feels would benefit from it.
GENERAL BEHAVIORAL HEALTH INTEGRATION MODEL
Medicare also covers general behavioral health integration (BHI), which is more basic and easier to fit into an existing chronic care management program than the psychiatric collaborative care model (CoCM). BHI can be provided by the physician or clinician alone or can include a behavioral health care manager (specialized training is not required for the behavioral health care manager in the BHI model). A psychiatric consultant is not necessary. The BHI model requires a minimum of 20 minutes per month checking on each enrolled patient, versus the 60 minutes required for CoCM. To bill for BHI, use code 99484, which pays $48.65 per month through Medicare, according to the 2019 Medicare Physician Fee Schedule (nonfacility national payment). Rural health clinics and federally qualified health centers must use different codes for BHI and CoCM. The University of Washington has developed a coding “cheat sheet” for those facilities.
HOW COLLABORATIVE CARE WORKS IN OUR SMALL-TOWN PRACTICE
Our clinic is a small, rural p
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