How the COVID-19 Pandemic has Affected Mental Health
May is Mental Health Month. This non-profit initiative by organizations, such as Mental Health America (MHA) and the National Alliance on Mental Illness (NAMI), is focused on helping people with mental health issues and promoting overall mental health. Observing Mental Health Month has gained new significance due to the impact of the coronavirus pandemic on mental health and wellbeing.
The World Health Organization defines mental health as "a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community."
Here are some key data points from the National Council for Behavioral Health: - 1 in 5 adults in America experiences a mental illness.
- Almost 1 in 25 (10 million) adults in America lives with a serious mental illness.
- One-half of all chronic mental illness begins by the age of 14; three-quarters by the age of 24.
- About 10.2 million adults have co-occurring mental health and addiction disorders.
Today, the nation is dealing with the devasting impact of the COVID-19 pandemic on mental health. The worry and anxiety brought on by social isolation and economic uncertainty is difficult to overstate.
Mental Health Implications of COVID-19 The 2020 Stress in America national survey from the American Psychological Association (APA) found that nearly 8 in 10 adults (78%) say the coronavirus pandemic is a significant source of stress in their lives. Coronavirus has also created new challenges for people already suffering from mental illness and substance use disorders, making them more vulnerable to SARS-CoV-2 infection and more severe consequences if affected. A research review led by Oxford Brookes University found that a large proportion of COVID-19 survivors will be affected by neuropsychiatric and cognitive problems. In the WHO Executive Board meeting held in January 2021, members highlighted the need to be better prepared to provide people with the support they need for their mental health during future public health emergencies.
COVID-19 has affected the mental health of just about every generational group-from young children and adolescents to young people, middle-aged adults, and older adults. Pandemic driven measures, such as the closure of restaurants, fitness centers, and workplaces, along with stay-at-home orders and "coronaphobia"-the fear of getting infected with the virus-have led to feelings of loneliness and exacerbated worry and stress. Pandemic-related consequences that impact both mental and physical health include:
- Concerns and fears about health, ongoing unemployment, and loss of income and support services
- Chronic loneliness
- Concentration problems
- Obsessive compulsive disorder (OCD), which is likely to be triggered or worsened by the stress of COVID-19
- Exacerbation of chronic conditions, including mental health conditions
- Trouble sleeping, disturbed sleep, or altered sleep patterns
- Unhealthy eating habits and weight gain
- Increased use of alcohol and other substances
What's especially disturbing is that experts say that many people could be left with mental health concerns that outlive the pandemic. A BBC report notes that this concern is based on insights from previous pandemics and national emergencies. The report references a study which linked the SARS global outbreak in 2003 to a 30% increase in suicides in people over the age of 65.
Psychotherapy, medication, case management, hospitalization for close monitoring, support groups, peer support, complementary and alternative medicine, and self-help are the different treatment options available for mental health concerns. People can choose the treatment, or combination of treatments, that works best for them.
The pandemic has increased the demand for mental health services, but are people getting the support they need? Access to mental health services have always been a challenge in the United States. There is a shortage of mental healthcare workers to meet the seemingly ever-increasing demand for treatment. Another problem is cost.
Mental and Behavioral Health Billing and Coding Today, telehealth is boosting mental health patient engagement. The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) passed in March 2020, which allocated funding for mental health and substance use services, as well as included several provisions aimed at expanding availability of telehealth and other remote care for those covered by government and private insurance programs. According to a study published in the Journal of General Internal Medicine, between mid-March and early May 2020, telehealth was used by more than 40% of patients with a chronic physical health condition and by more than 50% of those with a behavioral health condition. Outcomes for some conditions and circumstances are comparable to receiving in-person care.
The commonly used CPT codes for mental health services are:
- 90785 Interactive complexity add-on (for psychotherapy codes)
- 90791 Psychiatric or psychological intake interview without medical services
- 90792 Psychiatric intake interview with medical services
- 90832 Thirty minutes of individual psychotherapy
- 90833 Thirty minutes of individual psychotherapy performed with an E/M service
- 90834 Forty-five minutes of individual psychotherapy
- 90836 Forty-five minutes of individual psychotherapy performed with an E/M service
- 90837 Sixty minutes of individual psychotherapy
- 90838 Sixty minutes of individual psychotherapy performed with an E/M service
- 90839 Patient in crisis add-on-Sixty minutes
- 90840 Patient in crisis add-on-Each additional 30 minutes
- 90845 Other psychotherapy procedures, such as psychoanalysis
- 90846 Family psychotherapy without the patient present
- 90847 Family psychotherapy with the patient present
- 90849 Multiple-family group psychotherapy
- 90853 Group psychotherapy
- 90870 Electroconvulsive therapy (includes monitoring)
- 96105 Aphasia assessment
- 96111 Developmental Testing, Extended
- 96116 Sixty minutes Neurobehavioral Status Exam (clinical assessment of thinking, reasoning, and judgment)
- 96130 Sixty minutes Psychological testing evaluation services by physician or other qualified healthcare professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed
- 96131 Psychological testing evaluation services, each additional hour (to be listed separately in addition to code for primary procedure)
- 96132 Neuropsychological evaluation services, first hour
- 96133 Neuropsychological evaluation services, each additional hour (to be listed separately in addition to code for primary procedure)
- 96136 Thirty minutes Psychological or neuropsychological test administration and scoring by physician or other qualified healthcare professional, two or more tests, any method
- 96137 Psychological or neuropsychological test administration and scoring, each additional thirty minutes
- 96138 First thirty minutes Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method
- 96139 Psychological or neuropsychological test administration and scoring by technician, each additional 30 minutes (to be listed separately in addition to code for primary procedure)
There are also specific CPT codes for health behavior assessment and health behavior intervention. Health Behavior Assessment includes evaluation of the patient's responses to disease, illness or injury, outlook, coping strategies, motivation, and adherence to medical treatment. Health Behavior Intervention includes promotion of functional improvement, minimizing psychological and/or psychosocial barriers to recovery, and management of and improved coping with medical conditions.
- 96156 Health behavior assessment, or re-assessment (i.e., health-focused clinical interview, behavioral observations, clinical decision making)
- 96158 Health behavior intervention, individual, face-to-face; initial 30 minutes
- 96159 Health behavior intervention, individual, face-to-face; each additional 15 minutes
- 96164 Health behavior intervention, group (2 or more patients), face-to-face; initial 30 minutes
- 96165 Health behavior intervention, group (2 or more patients), face-to-face; each additional 15 minutes
- 96167 Health behavior intervention, family (with patient present), face-to-face; initial 30 minutes
- 96168 Health behavior intervention, family (with patient present), face-to-face; each additional 15 minutes
- 96170 Health behavior intervention, family (without patient present), face-to-face; initial 30 minutes
- 96171 Health behavior intervention, family (without patient present), face-to-face; each additional 15 minutes
Most health insurance providers reimburse for telemental health sessions conducted via synchronous audio-visual communication. Some payers also pay for sessions conducted over the phone. To submit accurate claims and get optimal reimbursement, providers should be aware of which services are eligible for reimbursement, their CPT codes, and each insurance provider's rules and billing guidelines.
Mental Health Month 2021 - Make Mental Health a Priority Virtual telemedicine, which advanced during the pandemic, has changed the way mental health is delivered and decreased the stigma surrounding seeking treatment for mental health concerns. Mental Health America is highlighting #Tools2Thrive in 2021 to provide individuals with information and coping strategies around common struggles that affect mental health—especially during the COVID-19 pandemic. Tools 2 Thrive provides practical tools that people can use to improve their mental health and increase resiliency regardless of the situations they are facing, support those who are struggling with mental health issues, and work toward a path of recovery.
As the nation observes Mental Health Month during the COVID-19 crisis, it is the time for everyone to come together and show their support for those who suffer from mental disorders and illnesses. End the stigma, raise awareness, and reach out to someone who may need your assistance.
Natalie Tornese, CPC, is Director Of RCM responsible for Practice and Revenue Cycle Management at MOS. She brings 25 years of healthcare management experience to the company. Natalie has worked in varied leadership roles with practices and specialties. Her primary focus is revenue cycle management with an emphasis on Medical Billing, Coding, and Insurance Verification Management.
She has written numerous articles on all aspects of Practice Management and presently manages a large team focused on Medical Billing, Medical Coding, Verification, and Authorization services for MOS. For more information on how MOS can help your practice, contact us
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 and the National Alliance on Mental Illness (NAMI), is focused on helping people with mental health issues and promoting overall mental health. Observing Mental Health Month has gained new significance due to the impact of the coronavirus pandemic on mental health and wellbeing.
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