CPT® Code 0359T | Case2Code

Code deleted, see 97151, 97152

Official Description

Behavior identification assessment, by the physician or other qualified health care professional, face-to-face with patient and caregiver(s), includes administration of standardized and nonstandardized tests, detailed behavioral history, patient observation and caregiver interview, interpretation of test results, discussion of findings and recommendations with the primary guardian(s)/caregiver(s), and preparation of report

Common Language Description

A behavior identification assessment is a comprehensive evaluation conducted by a physician or other qualified healthcare professional, aimed at diagnosing conditions related to maladaptive behaviors in patients. Maladaptive behaviors are those that hinder an individual's ability to adapt to everyday situations, often triggered by anxiety, leading to dysfunction or a lack of productivity. This assessment employs applied behavioral analysis and functional behavioral assessment methodologies to create an individualized treatment plan tailored to the patient's needs. The process involves a face-to-face interaction with both the patient and their caregivers, ensuring that all relevant perspectives are considered. During the assessment, a detailed behavioral history is gathered through interviews with the patient and caregivers, alongside direct observation of the patient’s behavior in various contexts. The administration of both standardized and non-standardized tests is a critical component of this evaluation, as it provides objective data to inform the diagnosis. Tests utilized may include well-established instruments such as the Scales of Independent Behavior-Revised (SIB-R), Vineland Adaptive Behavior Scales, and the Autism Diagnostic Observation Schedule (ADOS), among others. The assessment not only focuses on identifying the behaviors but also seeks to understand the underlying cultural, social, affective, cognitive, and environmental factors that may influence these behaviors. The ultimate goal is to pinpoint the causes and purposes of the maladaptive behaviors, allowing for the development of a strategic plan that promotes appropriate replacement behaviors that fulfill the same functions. This code encapsulates the entire untimed assessment process, which includes interpreting the findings, documenting test scores and observations, formulating treatment recommendations, and preparing a comprehensive report that is communicated to the patient, caregivers, and other involved professionals.

1. Indications

The behavior identification assessment is indicated for patients exhibiting maladaptive behaviors that interfere with their ability to function effectively in daily life. These behaviors may manifest in various forms and can be triggered by underlying anxiety or other psychological factors. The assessment is particularly relevant for individuals who require a thorough evaluation to understand the nature of their behaviors and to develop an appropriate treatment plan. The following conditions may warrant this assessment:

Maladaptive Behaviors Behaviors that inhibit an individual's ability to adjust to common situations, often resulting in dysfunction or non-productiveness.
Behavioral Concerns Situations where there are significant concerns regarding a patient's behavior that may affect their social, academic, or personal functioning.
Diagnosis of Behavioral Disorders Patients suspected of having behavioral disorders, such as autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD), or other related conditions.

2. Procedure

The behavior identification assessment involves several key procedural steps that ensure a comprehensive evaluation of the patient's behaviors. Each step is designed to gather critical information that will inform the diagnosis and treatment plan.

Step 1: Patient and Caregiver Interview The assessment begins with a face-to-face interview with the patient and their caregivers. This step is crucial for collecting detailed behavioral history and understanding the context of the patient's behaviors. The healthcare professional will ask questions about the patient's behavior patterns, triggers, and any previous interventions that have been attempted.
Step 2: Direct Observation Following the interview, the healthcare professional will observe the patient in a controlled environment. This direct observation allows the professional to assess the patient's behavior in real-time, noting any maladaptive behaviors and their frequency, intensity, and context.
Step 3: Administration of Tests The next step involves administering both standardized and non-standardized tests to evaluate the patient's cognitive and adaptive functioning. Tests may include the Scales of Independent Behavior-Revised (SIB-R), Vineland Adaptive Behavior Scales, and others. These assessments provide quantitative data that can help in diagnosing behavioral issues.
Step 4: Interpretation of Results After the tests are completed, the healthcare professional will interpret the results, analyzing the data collected from the interviews, observations, and tests. This interpretation is essential for understanding the underlying causes of the maladaptive behaviors.
Step 5: Discussion of Findings The healthcare professional will then discuss the findings with the primary guardian(s) or caregiver(s). This discussion includes an explanation of the results, potential diagnoses, and recommendations for treatment or further evaluation.
Step 6: Report Preparation Finally, a comprehensive report is prepared, documenting the assessment process, test scores, observations, and treatment recommendations. This report is communicated to the patient, caregivers, and other professionals involved in the patient's care, ensuring that all parties are informed and can collaborate on the treatment plan.

3. Post-Procedure

Post-procedure care following a behavior identification assessment involves several considerations to ensure the effective implementation of the treatment plan. After the assessment, the healthcare professional will provide the patient and caregivers with the written report, which includes detailed findings and recommendations. It is essential for caregivers to review this report thoroughly and discuss any questions or concerns with the healthcare professional. The implementation of the recommended treatment plan may involve follow-up appointments, additional assessments, or referrals to specialists, depending on the identified needs of the patient. Continuous monitoring of the patient's progress is crucial, as adjustments to the treatment plan may be necessary based on the patient's response to interventions. Caregivers are encouraged to maintain open communication with the healthcare team to facilitate ongoing support and ensure that the patient receives the most effective care tailored to their individual needs.

Short Descr	BEHAVIORAL ID ASSESSMENT
Medium Descr	BEHAVIORAL IDENTIFICATION ASSESSMENT
Long Descr	Behavior identification assessment, by the physician or other qualified health care professional, face-to-face with patient and caregiver(s), includes administration of standardized and nonstandardized tests, detailed behavioral history, patient observation and caregiver interview, interpretation of test results, discussion of findings and recommendations with the primary guardian(s)/caregiver(s), and preparation of report
Status Code	Carriers Price the Code
Global Days	YYY - Carrier Determines Whether Global Concept Applies
PC/TC Indicator (26, TC)	9 - Not Applicable
Multiple Procedures (51)	9 - Concept does not apply.
Bilateral Surgery (50)	9 - Concept does not apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	9 - Concept does not apply.
Co-Surgeons (62)	9 - Concept does not apply.
Team Surgery (66)	9 - Concept does not apply.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Procedure or Service, Not Discounted when Multiple
Berenson-Eggers TOS (BETOS)	M5B - Specialist - psychiatry
MUE	Not applicable/unspecified.