GUIDELINES FOR THE USE OF PSYCHOLOGICAL SERVICES · Web viewThe need to manage maladaptive communication (related to, e.g., high anxiety, high reactivity, repeated questions, or disagreement)

BOctober 2020

GUIDELINES FOR THE USE OF PSYCHOLOGICAL SERVICES

DIVISION OF VOCATIONAL REHABILITATION Florida Department of Education

The Florida Vocational Rehabilitation program receives 78.7 percent of its funding through a grant from the U.S. Department of Education. For the 2020 Federal fiscal year, the total amount of federal grant funds awarded were $153,000,001. The remaining 21.3 percent of the costs ($41,409,148) were funded by Florida State Appropriations.

Table of Contents

OVERVIEW...............................................................................................................................................................3

OBJECTIVES.............................................................................................................................................................3

SECTION I – EVALUATION........................................................................................................................................3

A. Diagnostic Work.......................................................................................................................................3

B. Individuals With Physical Disabilities........................................................................................................3

C. Individuals Needing Interpreter/Translator for Assessments -...................................................................3

D. Types of Testing, Evaluations and Assessments.........................................................................................4

E. Method of Administration, Fee Codes and Length of Time for Testing.......................................................4

F. Referral Questions....................................................................................................................................4

SECTION II – TREATMENT.........................................................................................................................................5

A. Duration...................................................................................................................................................5

B. Qualifications...........................................................................................................................................5

C. Tracking Progress......................................................................................................................................5

D. Provider of Services..................................................................................................................................5

E. Medication...............................................................................................................................................5

SECTION III – PSYCHOLOGICAL CONSULTATION........................................................................................................6

A. VR Psychological Consultation Code used for a Psychiatrist.......................................................................6

B. VR Psychological Consultation Code used for a Psychologist.....................................................................6

SECTION IV – CODES FOR DIAGNOSTIC/INTERVIEW/ASSESSMENT...........................................................................6

SECTION V – TESTING ADMINISTRATION AND SCORING CODES...............................................................................7

SECTION VI – TYPES OF SERVICES REQUESTED..........................................................................................................7

A. LEARNING DISABILITY ASSESSMENT/EVALUATION....................................................................................7

B. FULL NEUROPSYCHOLOGICAL ASSESSMENT/EVALUATION........................................................................9

FL VR Use of Psychological Services 1/2021 Page 1

C. ABBREVIATED NEUROPSYCHOLOGICAL ASSESSMENT/EVALUATION........................................................10

D. ATTENTION DEFICIT DISORDER/ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADD/ADHD)................11

E. AUTISM ASSESSMENT/EVALUATION.......................................................................................................12

F. GENERAL PERSONALITY ASSESSMENT/EVALUATION...............................................................................13

G. GENERAL INTELLECTUAL ASSESSMENT/EVALUATION..............................................................................14

H. ADAPTIVE FUNCTIONING ASSESSMENT/EVALUATION.............................................................................15

I. VOCATIONAL INTEREST ASSESSMENT/EVALUATION...............................................................................16

J. VOCATIONAL APTITUDE ASSESSMENT/EVALUATION..............................................................................17

SECTION VII – ADDITIONAL ASSESSMENT/EVALUATION COMPONENTS.................................................................18

A. STANDARD COGNITIVE PERFORMANCE TESTING.....................................................................................18

B. DEVELOPMENTAL TESTING.....................................................................................................................18

SECTION VIII – PSYCHOTHERAPY CODES.................................................................................................................19

A. PSYCHOTHERAPY CODES WITHOUT MEDICAL EVALUATION AND MANAGEMENT SERVICES....................19

B. ADD-ON PSYCHOTHERAPY CODES...........................................................................................................19

SECTION IX – CODES USED ONLY BY PSYCHIATRISTS...............................................................................................20

A. PSYCHIATRIC EVALUATION CODE............................................................................................................20

B. EVALUATION AND MANAGEMENT (E/M)................................................................................................20

SECTION X – BEST PRACTICES SUMMARY POINTS...................................................................................................21

SECTION XI – RESOURCES.......................................................................................................................................22

A. ATTACHMENT A – VR CODING REFERENCE..............................................................................................22

B. OTHER RESOURCES.................................................................................................................................22

C. LINKS TO FREE OR LOW COST MEDICATIONS...........................................................................................22

Should you identify needed changes within this Best Practices Guide or have questions on how to use this tool please contact [email protected]


mailto:[email protected]

OVERVIEWThese 2020 standards are based on Current Procedural Terminology (CPT) managed by the American Psychological Association (APA). CPT codes are a universal way to classify and describe all medical tests and procedures, and thus, is the basis for the Florida VR service fee code structure. CPT codes are five (5) digits, VR service fee codes are six (6) digits; therefore the last digit (a zero [0], or a one [1]) is for VR classification use only. Providers may vary slightly as to what codes are billed in their practice but these guidelines are provided as a starting point for the counselor to engage the chosen expert. All fees paid are regionally determined by the Centers for Medicare & Medicaid Services (CMS) and mental health professionals other than Psychologists or Psychiatrists are paid at varying levels. This best practices guide has been developed in partnership with several experts in the field; we would like to thank them and many VR field staff for their input and dedication to providing quality services.

OBJECTIVESThese guidelines highlight the established standards and policies for the use of mental health professionals within the Division of Vocational Rehabilitation (VR).

The goal of VR is to help individuals with disabilities find and maintain employment and enhance their independence.

SECTION I – EVALUATIONDiagnosis of mental health disabilities shall be made by a psychiatrist and/or a licensed psychologist. [Reference VR Counselor Policy Manual (CPM), Chapter 4, Section 4.12(1).] Diagnosis by a professional staff with less than an M.D. or Ph.D. credential is acceptable only if such individual(s) are employed by a licensed/certified facility with M.D. or Ph.D. oversight. Please note: Signature of the individual providing oversight is not required. [Reference CPM, Chapter 4, Section 4.11(2)]

A. Diagnostic Work – The psychologist can provide useful information during the diagnostic work-up of an individual. In addition to providing diagnosis of emotional disorders, learning disabilities, intellectual disabilities and neuropsychological issues, the psychologist can evaluate and provide information as to the nature of the individual’s vocational impediment. The psychologist can also provide impressions and recommendations regarding what specific aspect(s) of the individual’s mode of functioning would require an accommodation in order to obtain a successful employment outcome.

B. Individuals With Physical Disabilities – Very often psychological factors represent a significant aspect in the rehabilitation of individuals with severe physical disabilities. In many cases, a psychological evaluation is necessary to clarify variables such as: the individual’s emotional response to the disability, mechanisms for coping with the disability, adjustment potential, self-concept and other related factors.

C. Individuals Needing Interpreter/Translator for Assessments - Valid Assessments require effective communication. Some individuals have a language barrier due to using:1. a foreign spoken language (e.g. Haitian Creole), 2. American Sign Language (ASL), or 3. atypical language (e.g. foreign sign language, lack of formal education, or language influenced by cognitive

delays).

VR will arrange for any form of interpretation needed to secure a valid and reliable assessment. Interpreter(s) shall be used unless the psychologist is approved to conduct the assessment in the individual’s native language


(e.g. the psychologist is fluent in ASL). If the individual uses atypical language, a language specialist interpreter shall also be secured for the assessment, whenever possible. The psychologist performing the assessment must work with the interpreter(s) during at least the interview section, questions and answers (within the scope of the instrument’s directions and within acceptable nonstandard test administration protocols/techniques), as well as during the review of results. Interpreters will be used during any treatment plan activities to ensure full participation for the individual. All attempts will be made to have the same interpreter(s) for these sessions for the purpose of consistency. VR will provide interpreting services for treatment if needed, unless other sources are available.If effective communication requires assistance other than interpreting (e.g. CART, Braille docs, translated materials), VR will work to provide the alternative formats whenever possible).

D. Types of Testing, Evaluations and Assessments – The counselor will determine and communicate to the psychologist the purpose of the psychological evaluation in order to assist the psychologist in determining the battery of tests that will be required such as: intellectual, personality, learning disability, adaptive functioning and neuropsychological. The psychological evaluation should have some relevance for the counselor and the individual in establishing and developing a vocational goal. The counselor may also request recommendations regarding the nature of a job environment and/or training best suited for an individual based on his or her psychological profile.

Youth in Potentially Eligible status cannot receive psychological evaluations. Youth in other VR statuses may receive psychological evaluations.

Please note: Psychologists should not prescribe testing that the counselor does not deem necessary. The counselor and psychologist should discuss the need for any specific testing not on the original authorization.

E. Method of Administration, Fee Codes and Length of Time for Testing – The counselor will communicate with the psychologist to determine appropriate fee codes and which method of test administration should be used for the evaluation (psychologist, technician, or computer).

Please note: Specific codes are for varying units of time (half hour, 1 hour). A range of time allowed is identified for most codes. See Attachment A – VR Coding Reference for further assistance when requesting services and creating an authorization for services.

F. Referral Questions – It is important that the counselor obtain a psychological evaluation report of an individual that will include recommendations with vocational implications. To accomplish this, well-formulated referral questions will aid the psychologist in providing the type of information most useful to the referring counselor for a particular case. If a psychologist has a question as to the nature of the information being requested by a counselor, it is often useful for the psychologist to consult with the counselor and indicate the type of referral information generally needed for the psychologist to write the most useful reports in the future. (RIMS Template VCMT009, Request for Psychological Services)


SECTION II – TREATMENTIn cases where VR is funding treatment for medical, psychiatric or psychological services, the information can be no older than one year. [Reference CPM, Chapter 6, Section 6.04(2)].

A. Duration – Psychological treatment services may be provided to help the individual reach an employment outcome. The counselor must follow-up with the treatment provider for recommendations regarding treatment goals and length of treatment. The counselor may request psychological consultation as questions arise. From the standpoint of VR, any psychotherapeutic service would have, as a primary goal, the resolution of those psychological problems or issues, which are contributing to an individual’s inability to return to work or failure to maintain employment once placed on a job.

B. Qualifications – Licensed marriage and family therapists, licensed clinical social workers, licensed psychologists and licensed mental health counselors can provide personal adjustment counseling to individuals to assist them in modifying behaviors that interfere with employment. School psychologists cannot administer neuropsychological tests or formal personality tests like the Minnesota Multiphasic Personality Inventory – 2 (MMPI-2). School psychologists can administer IQ, achievement, and some rating scales assessing autism, learning styles, and adaptive functioning.

C. Tracking Progress – When requesting the provision of treatment services, the counselor will discuss with the provider the goals for treatment to ensure that there is a clear understanding of the purpose of this service to the individual. The provider must submit a written progress report to the counselor within ten (10) business days of the last authorized session [Attachment A – VR Coding Reference] indicating whether the individual is making progress as a result of the treatment. The counselor will assess if the individual is benefiting from this service in terms of an employment outcome and if there is a need to continue treatment.

D. Provider of Services – In cases where psychological treatment (including psychotherapy) has been recommended by a psychologist, psychiatrist or other physician, a counselor may authorize the psychologist to provide the treatment. In any case in which a physician is providing medical treatment and a psychologist is providing psychological treatment concurrently, both should be kept informed of any changes in the individual’s therapeutic regime, which would affect the treatment process. The local community mental health center should be considered as a comparable service for long-term psychotherapy, or when an individual no longer requires services from VR to achieve an employment outcome. [Reference CPM, Chapter 12, Section 12.03(2)]

E. Medication – VR may provide prescription drugs that are necessary to correct or treat a physical or mental condition that constitutes a substantial impediment to employment. [Reference CPM, Chapter 12, Section 12.00(6)]1. The counselor should obtain a written report from the prescribing physician that details the purpose of the

medication, length of projected use and any side effects. Questions regarding these reports may be discussed with the medical or psychological consultant.

2. The counselor must determine whether comparable services and benefits are available under any program other than VR to cover the costs of services. The counselor can further assist the individual by researching low/no cost medications. [See Resources section.]


SECTION III – PSYCHOLOGICAL CONSULTATIONA psychological consultant can play a significant role as a consultative resource to the counselor. The psychological consultant will review available data, psychological report(s) and other pertinent information and provide a written recommendation to the counselor as to actions to take with a given individual. The psychological consultant can also assist a counselor by making recommendations as to case management, providing relevant interpretation of psychological evaluations, counseling approaches, psychopathology, appropriate treatment, and prognosis. The psychological consultant may also assist the counselor in making a determination as to whether the individual will be able to benefit from VR services in obtaining employment by interpreting pertinent information.

A formal psychological consultation shall not occur with the actual provider of the diagnostic and treatment services under review, unless no other provider is available. [Reference CPM, Chapter 12, Section 12.01(5)] Please complete RIMS template, Medical/Psychological Template VCMT012.

A. VR Psychological Consultation Code used for a Psychiatrist 998882

B. VR Psychological Consultation Code used for a Psychologist 998881

The psychological consultation codes can be used by the psychological consultant to follow-up with the counselor. For example, it can be one to two hours, as needed.

SECTION IV – CODES FOR DIAGNOSTIC/INTERVIEW/ASSESSMENT (See Attachment A for further assistance)

A. Psychiatric Diagnostic/Interview – 1 Hour/1 per dayOne of these basic codes will be included in all service requests, assessments/evaluations.

PSYCHOLOGIST PSYCHIATRIST907910 907920

907910 – A Biopsychosocial (diagnostic by a licensed psychologist: diagnostic limited to 1 per day) evaluation may occur on different days. This code should be reported when the service is concluded.

907920 - A Biopsychosocial and medical assessment (diagnostic by a psychiatrist: diagnostic limited to 1 per day) that may occur on different days. This code should be reported when the service is concluded.

Evaluation Type Purpose Presenting Problem or Possible Diagnosis

Psychiatric Evaluation

Diagnostic by a Psychiatrist

- A Biopsychosocial and medical assessment (diagnostic limited to 1 unit per day.) This assessment that may occur over several days. This code should be reported when the service is concluded.


SECTION V – TESTING ADMINISTRATION AND SCORING CODES (All codes are considered to be Usual, Customary, and Reasonable. See Attachment A for further assistance.)

A. CODES FOR TEST ADMINISTRATION AND SCORING:

PSYCHOLOGIST/PSYCHIATRIST TECHNICIAN COMPUTER

General PersonalityGeneral IntellectualAdaptive Functioning EvaluationVocational Interest EvaluationVocational Aptitude EvaluationFull NeuropsychologicalAbbreviated NeuropsychologicalLearning Disability Evaluation

961360(First 30 minutes)

961380(First 30 minutes)

961460(No timeframe)

Each additional 30 minutes + 961370 + 961390

Standard Cognitive Performance Testing 961250(No timeframe)

SECTION VI – TYPES OF SERVICES REQUESTED (All codes are considered to be Usual, Customary, and Reasonable. See Attachment A for further assistance.)

A. LEARNING DISABILITY ASSESSMENT/EVALUATION


Learning Disability Evaluation

To measure academic success, reading, writing and comprehension levels. Detect learning disabilities (reading, math, written expression, etc.) and identify other cognitive difficulties.

- Transition students in Exceptional Student Education (ESE)

- Individualized Education Plan (IEP) Holders- Individuals with a history of failing classes in

school or being held back- Individual with deficits in recalling/memorizing

or understanding instruction or information.- Individual reports intellectual disability and/or

difficulty with learning in school. - Individual reports difficulty with school in

reading, writing and/ or math.

1. Neurobehavioral Status Exam – required for this type of assessment – 1-8 hours

961160 Neurobehavioral status exam – First hour (max 1 unit) + 961210 Each additional hour (max 7 units)

A neurobehavioral status exam is intended to describe the process of gathering clinical information that is used to assess brain dysfunction and the progression and change in symptoms over time, as given by the physician or psychologist with subsequent interpretation and report by the physician or psychologist. A physical health (vs mental health) diagnosis is associated with this code and is completed prior to the administration of neuropsychological testing. The status exam involves clinical assessment of the patient,


collateral interviews (as appropriate), and review of prior records. The interview would involve clinical assessment of several domains including, but not limited to, thinking, reasoning, and judgment (e.g., acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities). The clinical assessment would determine the types of tests and how those tests should be administered.It includes time for interpreting test results and report preparation. However, as the testing related to the neurobehavioral status exam is only done by the physician or psychologist, there are no codes for technician or computer administration.

2. Test Administration and Scoring – 4-6 Hours

PSYCHOLOGIST / PSYCHIATRIST961360 Two or more tests, any method – First 30 minutes (max one unit)

+961370 Each additional 30 minutes (max 11 units)

BY TECHNICIAN961380 Two or more tests, any method – First 30 minutes

+961390 Each additional 30 minutes

BY AUTOMATED/COMPUTER961460 Psychological or Neuropsychological test with single automated instrument

3. Test Evaluation (interpretation and report prep) - 2-4 Hours

961320 Test evaluation – First hour (max 1 unit)+ 961330 Each additional hour (max 3 units)

4. May also include…Developmental Testing (see Section VII-B for further information)

961121 Developmental Testing – First hour (max 1 unit) + 961131 Each additional half hour (max 3 units)


B. FULL NEUROPSYCHOLOGICAL ASSESSMENT/EVALUATION


Full Neuropsychological Evaluation

Used to assess an individual’s brain functions. Includes measures of processing speed, executive functioning, attention, learning, memory, language, nonverbal skills, orientation, visual perception, intelligence and may include measure of emotional functioning.

- Traumatic brain injury - Coma- Dementia- Stroke- Epilepsy- Brain Infections- Sudden change in cognitive functioning- Prolonged Substance Abuse- Falls or Accidents resulting in a loss of

consciousness

1. Neurobehavioral Status Exam – required for this type of assessment – 1-8 hours (See Neurobehavioral Status Exam under A. Learning Disability Assessment/Evaluation for further information)


2. Test Administration and Scoring (IQ testing always required) - 6-8 Hours

PSYCHOLOGIST / PSYCHIATRIST961360 Two or more tests, any method – First 30 minutes (max 1 unit)





3. Test Evaluation (interpretation and report preparation) - 3-5 Hours

961320 Test evaluation – First hour (max 1 unit) + 961330 Each additional hour (max 4 units)




C. ABBREVIATED NEUROPSYCHOLOGICAL ASSESSMENT/EVALUATION


Abbreviated Neuropsychological Evaluation

To gain information regarding processing speed, executive functioning, memory, language, nonverbal skills.

- Traumatic brain injury- Seizures- Multiple Sclerosis- Concussion- Stroke- Autism Spectrum Disorder (ASD), ADD,

ADHD, Prolonged Substance Abuse, Falls or Accidents that result in loss of consciousness.



2. Test Administration and Scoring (IQ testing always required) - 4-6 Hours







961320 Test evaluation – First hour (max 1 unit)

+ 961330 Each additional hour (max 3 units)




D. ATTENTION DEFICIT DISORDER/ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADD/ADHD)

ADD/ADHD is a neuropsychological process and may require more intensive data collection; preferably from family, peer, and work settings, if possible.

When additional diagnostics are requested, seek advice from your local psychological consultant. If you are not doing an academic assessment and want to rule out ADD/ADHD, use the following codes:


Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD) Evaluation

To measure an individual’s capacity to concentrate, information retention, distractibility, mental stamina, hyperactivity, behavioral symptoms (disruptive & impulsivity).

- ADD/ADHD is a neuropsychological process and may require more intensive data collection; preferably from family, peer, and work settings, if possible.

- Individuals who struggle to pay attention or with memory retention

- Students receiving accommodations under other health impaired (OHI)

- Individuals taking (or have taken) ADHD medications



2. Test Administration and Scoring - 3-5 Hours






3. Test Evaluation (interpretation and report prep) -2-4 Hours





E. AUTISM ASSESSMENT/EVALUATION


Autism Evaluation

To establish a diagnosis for Autism Spectrum Disorder.

- Prior diagnosis of Autism, Asperger’s or Pervasive Developmental Disorder

- History of developmental delays- Difficulty interacting with or relating to

individuals their own age- Social difficulties/Poor eye contact

1. Psychiatric Diagnostic/Interview – 1 Hour/max 1 unit per day


2. Test Administration and Scoring (IQ testing can be added if necessary) - 1-2 Hours

PSYCHOLOGIST/PSYCHIATRIST961360 Two or more tests, any method – First 30 minutes (max 1 unit)




BY AUTOMATED/COMPUTER961460 Psychological or Neuropsychological test with single Automated Instrument




F. GENERAL PERSONALITY ASSESSMENT/EVALUATION

Evaluation Type

Purpose Presenting Problem or Possible Diagnosis

General Personality Evaluation

To assess disorders associated with emotional distress that significantly and adversely affects how an individual functions.

- May present as: Depression, Anxiety, Post Traumatic Stress Disorder (PTSD, Mood disorder, Interpersonal Problems.

- Psychotic disorders- Personality disorders- Anxiety disorders- Depressive disorders- Bipolar related disorders- Trauma disorders- Dissociative disorders- Somatic disorders- Eating disorders- Gender Dysphoria- Conduct disorders- Persons with a history of behavioral problems, trouble

maintaining employment, hallucinations, delusions or psychotropic drug use.












G. GENERAL INTELLECTUAL ASSESSMENT/EVALUATION

Evaluation Type


General Intellectual Evaluation

To measure intellectual (IQ) and/or cognitive ability (aptitude/intelligence) relating to vocational goals. Feasibility of college or trade school, capacity to perform simple and complex tasks.

- Combine with Adaptive Functioning to determine intellectual disability.

- Use when individuals report receiving a Standard Diploma through access points.

- Partner with Learning Disability Assessment.



2. Test Administration and Scoring - 2 Hours

PSYCHOLOGIST OR PSYCHIATRIST961360 Two or more tests, any method – First 30 minutes (max 1 unit)







4. Must also include if evaluating for Intellectual Disability:

Adaptive Functioning Testing - 1 HourPSYCHOLOGIST OR PSYCHIATRIST

961360 Two or more tests, any method – First 30 minutes (max 1 unit) +961370 Each additional 30 minutes (max 1 unit)




H. ADAPTIVE FUNCTIONING ASSESSMENT/EVALUATION

If you are assessing whether or not an Intellectual Disability exists, you must also request a General Intellectual Evaluation (Reference Section VI, G).

Evaluation Type


Adaptive Functioning Evaluation

To measure the level of functioning of ADL (Activity of Daily Living skills) overall socialization and coping skills.

- Required to be included with General Intellectual Evaluation for evaluation of an Intellectual Disability.

- Assesses how effectively individuals cope with common life demands and how well they meet the standards of personal independence.

- Individuals with prior IQ below 70, prior history of Intellectual Disability (ID), or suspected Intellectual Disability.

- Students graduating with Special Diplomas or Certificates of Completion.

- Potentially for individuals with Cerebral Palsy, Traumatic Brain Injury or Autism to assess adaptive skills if deficits are known or expected.



2. Test administration and scoring (IQ testing can be added if necessary) - 1-2 hours









I. VOCATIONAL INTEREST ASSESSMENT/EVALUATION

Evaluation Type


Vocational Interest Evaluation

To assess an individual that is unsure or not clear of appropriate vocational interests.

- Vocational interest evaluations help individuals who are changing careers, returning to work or entering work for the first time to determining their career interests.

- Not necessary if planning to complete a vocational evaluation.

1. Psychiatric Diagnostic/Interview - 1 Hour/max 1 unit per day


2. Test Administration and Scoring – 1-2 Hours







961300 Test evaluation – First hour (max 1 unit) + 961310 Each additional hour (max 1 unit)


J. VOCATIONAL APTITUDE ASSESSMENT/EVALUATION

Evaluation Type


Vocational Aptitude Evaluation

To give an indication of which jobs match the individual’s personality, overall aptitude and skill level.

- Vocational Aptitude Evaluations help individuals who are changing careers, returning to work or entering work for the first time to determine either best career options or what level of work they are most suited for.

- Assess individuals’ vocational aptitudes. Not necessary if planning to complete a vocational evaluation.








BY AUTOMATED / COMPUTER961460 Psychological or Neuropsychological test with single automated instrument


961300 Test evaluation – First hour (max 1 unit) + 961310 Each additional hour (max 1 unit)


SECTION VII – ADDITIONAL ASSESSMENT/EVALUATION COMPONENTS

A. STANDARD COGNITIVE PERFORMANCE TESTINGBrief testing component used with other diagnostic assessments.


Standard Cognitive Performance Testing

Cognitive testing checks for problems with cognition. Cognition is a combination of processes in your brain that's involved in almost every aspect of your life.

- Forgetting appointments and important events- Losing things often- Having trouble coming up with words that you

usually know- Losing your train of thought in conversations,

movies, or books- Increased irritability and/or anxiety- It includes thinking, memory, language,

judgment, and the ability to learn new things. A problem with cognition is called cognitive impairment. The condition ranges from mild to severe.

- There are many causes of cognitive impairment. They include side effects of medicines, blood vessel disorders, depression, and dementia.

- Cognitive testing can't show the specific cause of impairment. But testing can help determine if more tests are needed and/or identify steps to address the problem.

961250 No time frame (max 1 Unit add-on)

B. DEVELOPMENTAL TESTINGThe developmental testing codes, may vary by provider, but should be reported when a standardized instrument is used to assess developmental skill acquisition or developmental status. Developmental testing measures skill development in multiple areas, such as receptive and expressive language and social, cognitive, gross and fine motor, and adaptive functioning.

The main distinction between these developmental testing codes and the neurobehavioral status codes is the use of a standardized element. The neurobehavioral status exam does not require the completion of a standardized instrument. It represents an interview to collect clinical information, often before formal testing begins.



SECTION VIII – PSYCHOTHERAPY CODES (Use in all settings; time is with patient and/or family ONLY; Pays 25% less to mental health professionals other than psychologists or psychiatrists)

Evaluation Type Purpose Presenting Problem or Possible DiagnosisPsychotherapy Often used as a

general category to describe a therapeutic meeting, or referenced as a treatment approach, or long-term therapy

- Not a diagnosis- Used with or without an add-on (or pair)

code

A. PSYCHOTHERAPY CODES WITHOUT MEDICAL EVALUATION AND MANAGEMENT SERVICES

908320 30 minutes908340 45 minutes (standard)908370 60 minutes

B. ADD-ON PSYCHOTHERAPY CODESPsychotherapy with medical evaluation and management services are reported with a psychotherapy add-on code. For Psychotherapy sessions lasting longer than 90 minutes, reimbursement will only be made if the report is supported by the medical record documenting the face-to-face time spent with the patient, and the medical necessity for the extended time.

+ 908330 Individual and family member –30 minutes + 908360 Individual and family member – 45 minutes + 908380 Individual and family member – 60 minutes

+ 907850

Interactive complexity – when specific communication difficulties are present with individuals who typically: 1. Have other individuals legally responsible for their care, such as minors

or adults with guardians, or 2. Request others to be involved in their care during the visit, such as adults

accompanied by one or more participating family members or interpreter or language translator, or

3. Require the involvement of other third parties, such as child welfare agencies, parole or probation officers, or schools.

Interactive complexity may be reported with psychiatric procedures when at least one of the following communication difficulties is present: 1. The need to manage maladaptive communication (related to, e.g., high anxiety, high reactivity, repeated

questions, or disagreement) among participants that complicates delivery of care. 2. Caregiver emotions/behaviors that interfere with implementation of the treatment plan. 3. Evidence/disclosure of a sentinel event and mandated report to a third party (e.g., abuse or neglect with

report to state agency) with initiation of discussion of the sentinel event and/or report with patient and other visit participants.


4. Use of play equipment, physical devices, interpreter or translator to overcome significant language barriers.

SECTION IX – CODES USED ONLY BY PSYCHIATRISTS

A. PSYCHIATRIC EVALUATION CODE907920 Psychiatric Diagnostic/Interview 1 Hour/1 unit per day

B. EVALUATION AND MANAGEMENT (E/M) Codes are only based on the time frame and meeting all components detailed in each description. These codes are generally used for medication management.

Evaluation Type Purpose Presenting Problem or Possible DiagnosisMedication Management

Medication Management is used by a Psychiatrist to review and determine effectiveness of medical care plan.

- Not a diagnosis- Often referred to as an Evaluation/Maintenance

(E/M) coding- Psychotherapy with medical evaluation and

management services are reported with a psychotherapy add-on code.

New Patient (face-to-face with patient and/or family)For new patients, three (3) components are required. For example: 992021 - Problem-focused history; problem-focused examination; and medical decision making/20 minutes. The 3 components of that fee code would be 1) history, 2) examination and 3) medical decision making.

992021 20 minutes992031 30 minutes992041 45 minutes992051 60 minutes

Established Patient (face-to-face with patient and/or family)For established patients, two (2) out of the three (3) components are required.

992111 5 minutes (This fee code does not have associated components)992121 10 minutes992131 15 minutes992141 25 minutes992151 40 minutes


SECTION X – BEST PRACTICES SUMMARY POINTSA. It is important that the counselor obtain a psychological evaluation report of an individual that will include

recommendations with vocational implications. To accomplish this, well-formulated referral questions will aid the psychologist in providing the type of information most useful to the referring counselor for a particular case. If a psychologist has a question as to the nature of the information being requested by a counselor, it is often useful for the psychologist to consult with the counselor and indicate the type of referral information generally needed for the psychologist to write the most useful reports in the future.

B. Per the APA, “It is absolutely essential that all of the Testing Evaluation Services and Test Administration and Scoring services provided by the psychologist/neuropsychologist and technician are documented in a comprehensive and transparent way. This should include a table within the report listing dates and total times for each activity, (including scoring and clinical decision making), as well as a log sheet with clear start/stop times in the clinical chart.”

C. When requesting the provision of treatment services, the counselor will discuss with the provider the goals for treatment to ensure that there is a clear understanding of the purpose of this service to the individual.

D. Please note: Psychologists should not prescribe testing that the counselor does not deem necessary. The counselor and psychologist should discuss the need for any specific testing not on the original authorization.

E. Ask the provider before appointment how many units of +961370 and how many units of +961310 (or +961330) they anticipate.

F. There are different codes for the first unit and then the additional units of each type of service. We refer to them as code pairs. The additional units of each type are in purple font and have a plus sign (+) before the code, see coding examples below.1. The VR guidance documents have each type of evaluation listed separately, but often, the request is for a

combination of types. For example, you want an LD and a GP. You can only use the “first unit code” one time on each authorization. Even though it is listed once under LD and once under GP. (See Attachment A – VR Coding Reference)

G. VR’s guidelines have the number of UNITS per type of testing. However, some units are in hours and some units are in 30 minute increments. Make sure to do the math if it is a 30 minute code. 1. For example, Test Administration and Scoring - 2-3 Hours

PSYCHOLOGIST/PSYCHIATRIST

961360 Two or more tests, any method – First 30 minutes (max 1 unit)


2. Another example, Test Evaluation (interpretation and report prep) - 2-4 Hours

961300 Test evaluation – First hour (max 1 unit)

+ 961310 Each additional hour (max 3 units)

H. The counselor will communicate with the psychologist to determine appropriate fee codes and which method of test administration should be used for the evaluation (psychologist, technician, or computer).


I. ALL Test Administration and Scoring codes are the same. It doesn’t matter if it is IQ, GP, LD, or Neuro. To administer and score, it is always 961360/+961370. These are all 30 min codes. The abbreviated neuro status is still 961160 for the first hour.

J. Report writing and interpreting. 1. If the report is a psychological (GP/LD/AF/Voc int/Voc apt) then the codes for report writing are

961300/+961310. 2. If it is a neuropsychological (or abbreviated, LD, or ADHD) it is 961320/+961330, these are all hour long

codes.

SECTION XI – RESOURCES

A. ATTACHMENT A – VR CODING REFERENCE This attachment offers an alternative view of these codes based on the type of assessment/evaluation requested. Attachment A may be helpful for VR staff when developing an authorization on which codes to include on the starting number of units to authorize. A best practice is to learn from and work in partnership with your chosen vendor. Note in Attachment A we have provided a standard number of units, per code that are appropriate levels to create an authorization. Should your chosen vendor require more units then they should provide VR an explanation as to why they needed the additional time. Be sure to review the additional guidance provided within Attachment A.

Attachment A – VR Coding Reference

B. OTHER RESOURCES

1. American Psychological Association Guidance Documents, 2019I. 2019 Psychological and Neuropsychological Testing CPT Codes & Descriptions

II. APA Psychological FAQs III. Crosswalk for 2019 Psychological Testing and Evaluation CPT Codes IV. Crosswalk for 2019 Neuropsychological Testing and Evaluation CPT Codes V. Crosswalk for 2019 Computerized Test CPT Codes

2. Centers for Medicare & Medicaid Services, Evaluation and Management Services

C. LINKS TO FREE OR LOW COST MEDICATIONS

1. Medicine Assistance Tool

2. National Alliance on Mental Illness (NAMI) - Getting help paying for medicines

Should you identify needed changes within this Best Practices Guide or have questions on how to use this tool please contact [email protected]


mailto:[email protected]

https://www.nami.org/find-support/living-with-a-mental-health-condition/getting-help-paying-for-medications

https://medicineassistancetool.org/

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/eval-mgmt-serv-guide-ICN006764.pdf

https://www.apaservices.org/practice/reimbursement/health-codes/testing/computerized-test-codes.pdf

https://www.apaservices.org/practice/reimbursement/health-codes/testing/neuropsychological-testing.pdf

https://www.apaservices.org/practice/reimbursement/health-codes/testing/psychological-testing.pdf

https://www.apaservices.org/practice/reimbursement/health-codes/testing-code-faq.pdf

https://www.apaservices.org/practice/reimbursement/health-codes/testing/codes-descriptions.pdf

http://vrinet/bureaus/fs/pa/_layouts/15/DocIdRedir.aspx?ID=VRIDFS-630697654-41