Bulletin ID: 95 

Issued Date

December 19, 2013

Effective Date:

December 19, 2013

Termination Date:

 

COMMUNITY SUPPORT PHYSICIAN TEAM MEMBER (H0036AM):

This bulletin clarifies the documentation needed to appropriately bill the Community Support Physician Team Member (H0036AM) code.  This code was established to facilitate the inclusion of Community Support Workers in Medication/Somatic appointments.  

 

Documentation:

Department of Behavioral Health policy #1000.2A, MHRS Provider Authorization and Billing Manual provides the following description of the Community Support Physician Team Member (H0036AM) code:

H0036AM Physician Team Member procedure code should be used for community support (required by the consumer’s approved IRP/IPC) that is provided by a community support worker (CSW)/peer specialist in conjunction with medication somatic services, when both services are provided at the same time.  Medication/somatic is a rehabilitation service that must be rendered by a psychiatrist, or an APRN [or RN] working in collaboration with a psychiatrist.  The psychiatrist and the CSW/peer specialist must appropriately document the visit, including the reason for the CSW/peer specialist participation, and the documentation needs to be consistent with the IRP/IPC.  The IRP/IPC needs to describe the specific intervention that will be provided by the CSW/peer specialist; such as:  support during stressor situations, education and support for the consumer, assistance with self-monitoring and medication compliance and be specifically tied to the consumer’s diagnosis and needs.  (Appendix A, P.3, FN)

 

The intent of this bulletin is to clarify the documentation requirements of the service.  Clarification 1:  It is sufficient to list Community Support on the Individual Recovery Plan (IRP).  The IRP does not need to specifically list the Physician Team Member service in order for the service to be provided in accordance with medical necessity.  Clarification 2:  To establish medical necessity for this service it is sufficient to list general goals consistent with receiving support during psychiatric appointments on the IRP.  Those supports and interventions must then be reflected in the encounter note for any service billed as H0036AM.  Clarification 3:  Notes that are simply some variation of “Accompanied consumer to psychiatric appointment,” do not sufficiently document a community support intervention.  The note must describe a medically necessary service provided to the consumer during the psychiatry appointment.