Getting the Right Kind of Behavioral Medicine Evaluation
By Dr. Phil Appel

When requesting a Behavioral Medicine consultation, seek out psychologists who specialize in working with medical/surgical or pain patients, rather than mental health patients. Find professionals whose practice has — at a minimum — 65% of these types of patients.

Next, send a letter stating that you are requesting a consultation and authorizing an Initial Health Assessment (4 units; CPT 96150). Be sure to provide the medical diagnosis and ask that the consult includes the following questions (in addition to any questions you would like answered):

1. What is the patient's understanding of his medical condition and the treatment needed to restore his functional capacity and return to work?
2. How is he responding to pain and limited functional capacity?
3. Are there any beliefs or behaviors that are interfering with his ability to fully participate in medical treatment?
4. Are there any psychosocial reinforcers that may be affecting illness, injury or pain behavior?
5. How would you assess the patient's motivation for rehabilitation and return to work?
6. What does the patient need to learn in order to be able to respond and care for himself and his medical condition?
7. Do you have any recommendations for the treating physician or physical therapist on how best to help the patient achieve their rehabilitation and vocational goals as a disabled individual?

By indicating that you are looking for a health assessment and authorizing CPT 96150, the practitioner cannot bill using the traditional mental health initial evaluation code which requires a psychiatric diagnosis (CPT code 90801).

By asking these questions, you can steer the consultation towards the relevant issues.