Understanding Our Practice Philosophy and Billing Procedures
Thank you for choosing Behavioral Medicine P.C. (BMPC). We understand you have a choice in your care, and we are honored you have chosen us. This document will help you understand our practice philosophy and our billing procedures. The clinicians working at BMPC believe that the mind, body and spirit are connected. This has an impact on how we practice and how we bill. There is a vast and growing body of clinical research that provides evidence that the mind influences the body and visa versa.
The insurance/billing world speaks in terms of International Classification of Diseases 10th edition or (ICD-10 Codes) which are Diagnosis codes and Current Procedural Terminology (CPT codes) which are Procedure codes. These codes tell insurance why we are billing and what we have done to help the why.
There are classes of CPT codes that were developed over two and a half decades ago to indicate when a clinician is treating the connection between the mind and the body. These codes are called Health and Behavioral Codes or 96 codes. All Health and Behavioral codes start with numbers 96. These codes are made to treat the individual and their support system in addressing how the mind and body interact. These codes were updated in 2020..
Click here for a description of the Health and behavioral codes provided by the American Psychological Association.
Despite these codes being utilized for over two and a half decades, insurance companies can at times make it confusing or are confused about the application and use of these Health and Behavioral codes. Some insurance companies run the codes under the mental health portion of the insurance policy, others run it under the medical portion. How insurance companies choose to designate and pay for codes is up to each insurance policy. Unfortunately, at times this can result in inconsistent information being provided to our administrative billing staff and/or you as the patient in attempting to understand insurance coverage. We make every effort to help contact insurance companies and pass along the information provided to us. Please know we offer this service as a courtesy. It is each patient’s responsibility to understand and ultimately pay for services provided to them regardless of insurance coverage. With that being said, our goal is to improve the quality of your life, not add stress to it. That is why we are providing this information to you. We are also more than willing to answer any questions you have.
Cynthia Kindgren MS/LCPC, Clinical Director of BMPC, was first introduced and trained to use these codes in 1999, while working in the Neuropsychological Department at Van Mater Rehabilitation Center in Rockford IL. These codes are used on an inpatient and outpatient basis to treat people for a variety of reasons and diagnoses. Cynthia treated people using Health and Behavioral codes with diagnosis including, Traumatic Brain Injury, Stroke, Multiple Sclerosis, Obesity, Diabetes, Chronic Pain, Hypertension, Cardiac Issues, Gastrointestinal issues, Attention Deficit Hyperactivity Disorder, Eating Disorders, Autoimmune Disorders, Concussion, Migraines, Headaches, Insomnia, Amputation, Cardiac issues, High Blood Pressure, Diabetes, Debility due to depression or another illness, Dementia, Parkinson's Disease, Alzheimer's, other Memory Disorders, Infections and many others.
A large percentage of the people admitted to the rehabilitation center had co-occurring diagnosis of Anxiety, Depression, Post-Traumatic Stress Disorder, Panic Disorder, Impulse Disorder or other diagnosis. In the Rehabilitation Center and in our private practice on an outpatient basis, Health and Behavior, 96 codes are used to treat the connection between the mind and the body in each of these instances listed above.
There is also significant research about the connection between Adverse Childhood Experiences (ACE) and the development of chronic medical issues. For every additional reported ACE above 3 a patient has a 21% increased chance of having a chronic medical condition (OR=1.21, 95% CI: 1.05, 1.40). At least 5 of the top 10 leading causes of death are associated with ACEs. Any psychological diagnosis-ADHD, OCD, PTSD, Anxiety, Depression can be billed using 96 codes because studies show these diagnoses alone and combined with Adverse Childhood experiences increase their likelihood of developing a chronic medical condition. Even if they don’t have a medical diagnosis yet, 96 codes can help with preventing this from happening.
If you are coming to our office because you are experiencing Anxiety, Depression, ADHD, Trauma or any other mental health issues, your clinician will help reduce your symptoms and understand the relationship between your mental and physical health. We will ask about your sleep, headaches, history of concussion/head injury, gastrointestinal issues and nutritional/exercise choices. You may already be being treated for, struggling with or referred to our office for health issues such as Concussion, Traumatic Brain Injury, high blood pressure, Diabetes, Insomnia, Obesity, Chronic pain, autoimmune disorder, Migraine/headache, other diagnosis.
On the other hand, or in addition to, you may have experienced Adverse Childhood Experiences which put you at risk for developing a chronic medical condition. Your clinician will evaluate you from a mind/body connected approach with a goal of helping you improve the overall quality of your life. If you have clinical questions, please talk with your clinician. If you have billing questions please talk with our director of operations, Jeff Kindgren.
Thank you again for choosing BMPC. We look forward to working with you.
Sincerely,
BMPC staff
