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Point-of-care tests in behavioral health

April 1, 2006
by William M. Glazer, MD
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Glucose monitoring and a new lithium test can provide instant results to patients and clinicians

In addition to the charge for the lithium level test and the finger-stick procedure, providers will seek reimbursement through other CPT Codes.17Table 2 shows typical codes a psychiatrist could bill for after performing an instant lithium test during a regularly scheduled visit. The existing CPT codes in behavioral healthcare do not consider this new technology, which bridges treatment and testing. In this scenario, the patient was scheduled for a visit, so the provider usually would bill under 90862. Yet the time to perform the in-office lithium test and collaborate with the patient regarding findings is not incrementally reflected in the 90862 code, and the prescriber has no existing option to upgrade the charge.

One solution would be for the behavioral health prescriber to use the Evaluation & Management (E&M) 992 code series, in which it would be possible to upgrade the charge to reflect the additional time associated with the instant lithium test. This option is available for POC testing in general medicine, but many plans are rejecting this code series in an attempt to slot behavioral health reimbursement charges into the 908 CPT code series. The need for a fairer level of reimbursement for POC testing in the behavioral health arena is a new challenge for stakeholders.

Conclusion

Technologic advances are expanding POC testing dramatically. POC tests will raise the bar of quality of care in medicine. Such testing is beginning to occur in behavioral health settings and, as it does, payers will have to rethink current reimbursement strategies if these tests are to be available to patients.

William M. Glazer, MD, is President and Chief Medical Officer of ReliaLab, maker of the InstaRead Lithium System, a point-of-care test for blood lithium levels.

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