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P-221 Integration of Clinical Psychology into a Multidisciplinary Pediatric IBD Clinic

Background:Anxiety and depression have been shown to be increased in IBD patients. Screening for anxiety and depression is recommended for pediatric IBD patients. Impaired mental health can hinder physical recovery from disease. Psychology support in a multidisciplinary IBD clinic can help identify and address these issues. Unfortunately, cost of mental health care is one of the barriers to provision of psychology services to IBD patients. Our center has been able to integrate a clinical psychologist into our multidisciplinary pediatric IBD clinic. We describe our experience with billing codes and reimbursement, with the goal of sharing the knowledge for other IBD clinics to be able to incorporate psychology services into their clinics. Methods:Over the course of a 7 month pilot trial, our psychology provider (T.Z.) has seen a median of 7 (range 3–9) patients per half-day pediatric IBD clinic session. T.Z spends 15 to 20 minutes with each patient, reviewing the results of their anxiety (SCARED Child version) and depression (CES-DC) screens. He provides coping strategies as appropriate. He makes referrals for outpatient behavioral health (e.g., individual, family or group), if needed. The billing codes used are health and behavioral assessment codes including 96150, 96152, 96154 and 96151. The reports generated by our billing department provided type of primary insurance (government, commercial or self-pay) and number of days until reimbursement for patients seen in the monthly pediatric IBD clinic from January 2015 through July 2015. Results:Of 40 patients seen by our clinical psychologist from January 2015 through July 2015, reimbursement was received for 26 patients (65%). Of patients for whom no reimbursement was received, 5/14 (35.7%) had commercial insurance. 21/40 (52.5%) of the patients had commercial insurance with the rest having government insurance. Median time from appointment to payment was 26 days for commercial insurance with range of 14 to 113 days. For patients with government insurance, median time to payment was 23 days with range of 13 to 51 days. Conclusions:The need for psychology care for IBD patients is recognized. One of the barriers is reimbursement for the mental health provider. By using health and behavioral assessment codes including 96150, 96152, 96154 and 96151, our clinical psychologist has been able to bill for his services and receive some reimbursement from both commercial and government insurance. We believe that addressing the issue of reimbursement and including psychology in our IBD clinic has improved our patients' access to mental health services, an important component in taking care of the whole patient. Psychology providers can be successfully integrated into a multidisciplinary IBD clinic and reimbursed for the care they provide. We hope that other centers will find our model useful in helping take care of their patients.