Can we bill sufficiently for Mental Health Services while a patient is admitted for a different dx?

[Pakku-man]

Hello everyone,

I will be starting out as an medicine attending soon and wondered about the following question: "Is there meaningful financial support with medicare or private insurance that would help hospitals afford and provide mental health services such as cognitive behavioral therapy?"

Example scenario: Let's say my patient's son died and she has NYHA III heart failure and presents with an acute exacerbation. She is failing to take care of herself with her medicines due to lack of motivation and depression but is without suicidal thinking or other variables to warrant her to be transferred into a mental health facility.

The reason as to why I am asking these questions: other than the VA and a trauma hospital I have worked in, I have worked in two other hospitals that did not have a dedicated inpatient psychiatry service and I feel my mental health training is lacking to see what I believe is meaningful care that is not be provided. And if there are inpatient psychiatry services in other hospitals, what other mental health services other than changing medicine dosages and evaluating decision-making have you all seen in your experiences?

Follow up question: would it be practical for a hospital facility to implement a behavioral health team that can provide cognitive behavioral therapy (My speculation: is there no compensation and the program would be terminated as there is no money to keep such services running?).

Thank you all in advanced.

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[Sushirolls]

There are therapy add on codes to standard E&M codes. You are doing follow up visit on the floors, and you usually submit a level 1, 2 or 3 E&M code. You also have the ability to do an add on code 90833 for therapy services. The real question is, will the insurance company and the contract it has with your hospital/group/speciality pay for the CPT code and you delivering the services.

Another option is get a Masters level social worker to do that on the floors. However, in the hospital doing a one visit CBT isn't as important as you simply being emapthetic, and helping to convince the patient that follow up to a therapist. Ideally some primary care clinics, are larger specialists clinics will have a desginated psychologist who is labeled as a 'health psychologist' who helps people with chronic medical conditions to improve their adherence and own self care.

If the patient is depressed, discuss the merits of an SSRI, zoloft, celexa, lexapro, etc, pick one, get it started and then have the unit social worker assist in referring to a psychiatrist.

Even when you do have a Consultation & Liaison Psychiatrist in the hospital to consult on these depressed patients, they will usually do more supportive therapy then CBT while on the medical floors.