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FZCFernZagorConsultingLLC

telemedicineinitiated

patientcallsprovider accessforcrisis

providecrisisserviceusingroutinecodesanddocumentation

provideacomplexcareserviceusingroutinecodesanddocumetation

Provideanonbillableservicesuchasrescheduling,orwellnesscheck.document

asyounormallywould

provideanunscheduled telemedicineservice.useappropriateservicecodewith

modifierandlocationcodechanges.Documentnormallybutbesuretodenoteprovisionusingtelephonicequipmentand

patientconsent.

providercontactsstaffforscheduledsession accessforcrisis

providescheduledtelemedservice.Documentnormallybutbesuretodenoteprovisionusingtelephonicequipmentand

patientconsent.

providecrisisserviceusingroutinedocumentation andcodes

ServiceDeliveryDecisionTreeandGuidance

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FZCFernZagorConsultingLLC

HOWTOTELLIFSOMEONEISEXPERIENCINGACRISISONTHEPHONE:TheNAMIresourceguide,NavigatingaMentalHealthCrisisstatesthatmanythingscanleadtoMentalHealth/SUDcrisis;homeandenvironmentalstressorssuchaslossofanykind,trauma,conflictsandargumentswithlovedones-Schoolorworkstressors,worryingaboutcompletingtasks,lackofunderstandingfrompeerscoworkers,fallinggradesorlosingajob-OtherStressors,stoppingmedication,isolationandexperiencingcommunitynaturaldisasters.ItiseasytoseehowmanyofthesestressorscouldbeexperiencedduringtheCovid-19Pandemic.WarningsignsTypically,whenmeetingwithaclientfacetoface,itiseasiertoidentifysignsthatindicateapotentialcrisisthanitmaytelephonically.Andwhileeverycrisisisnotprecipitatedbywarningsigns,forthosethatareitwillbeimportantforproviderstoascertainthosesignsthroughconversation.Herearesomesuggestions.

Warningsigntolookforinfacetofacesessions

Howtoaccessonthephone Copingmechanisms

Inabilitytoperformdailytaskslikebathing,brushingteeth,brushinghair,changingclothes

Besuretoaskaboutiftheyhavedevelopedandarestickingtoaroutineatthistime.AskwhattheydothroughoutadayAskchangestheyhavebeenabletomakeforthegoodandbad

Helpthemdevelopascheduleorcreateachecklist.

Increasedagitationverbalthreats,violent,outof-controlbehavior,destroysproperty

Payattentiontothetone,volumeandinflectionoftheindividual’svoice.Listenforviolentoraggressivestatements,andorprofanity.Listenforabruptone-wordanswers

Identifycopingmechanismsusedintreatmentpreviouslyorinitiatenewonessuchasbreathingtechniques,stretching,singing,creatingart,dancing,yoga,journaling,removingthemselvesfromtheroom.Completeahomicidal/suicidalassessmentDevelopasafetyplan

Isolationfromschool,work,family,friends

Clearly,individualsareisolatedatthistimebutaretheycommunicatingwithothers?Doothers

Helptheindividualidentifywaysinwhichtostayconnectedandcommitto

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FZCFernZagorConsultingLLC

liveintheirhome,dothosepeoplecometogetherorremainapart?Ifsomeonelivesalone,askhowtheyarestayingconnectedtofriends,familypeers,socialgroups.Identifyhowmuchtimeisspentlisteningorwatchingnews/posts/blogs,etc.abouttheCovid-19versusnonvirus-relatedtopics.

conversations/activitiesthatdon’tdiscusstheCovid19.Helptheindividualidentifycurrent,previousornewintereststheymayhave.Discusswaystostayengaged.IdentifyhowtolimittheamountoftimespentontheCovid-19coverage.

Rapidmoodswings,increasedenergylevel,inabilitytostaystill,pacing;suddenlydepressed,withdrawn;suddenlyhappyorcalmafterperiodofdepression

Payattentiontohowfastorslowsomeonespeaks.Listenforverbalticksortapping/clicking.Payattentiontohowquicklytheindividualchangestopicsandtheirmoodwhendiscussingthem.

Attempt grounding exercises, try and getthe individual to joinyouorhave themdoany of the following: Working backwardfrom 5, have them use their senses to listthings they notice around them. Forexample, they might start by listing fivethingstheyhear,thenfourthingstheysee,thenthreethingstheycantouchfromwherethey’re sitting, two things they can smell,andonethingtheycantaste.Asktheindividualtoholdapieceofice,Pickupitemsaroundthemandnamethem,spellthemforwardsandbackwards,Movetheirbodytodoasimplestretchortryjumpingjacks.Once grounded, assess forsuicidality/homicidally and complete asafetyplan.Iftheycan’tsettledown,identifycrisisservicestheycanaccess.

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FZCFernZagorConsultingLLC

Whenworkingwithindividualsdemonstratingcrisiswarningsigns,besuretokeepyourvoicecalm.

✔Avoidoverreacting

✔Listentotheperson

✔Expresssupportandconcern

✔Askhowyoucanhelp

✔Keepstimulationlevellow

✔Speakslowlyandclearly

✔Offeroptionsinsteadoftryingtotakecontrol

✔Bepatient

✘Don’tmakejudgmentalcomments✘Don’targueortrytoreasonwiththepersonMoreinformationisavailableat:https://www.nami.org/About-NAMI/Publications-Reports/Guides/Navigating-a-Mental-Health-Crisis/Navigating-A-Mental-Health-Crisis.pdfDEFINITIONSCrisisCrisisIntervention/BriefThismaybedoneface-to-faceorbytelephoneforservicesatleast15minutesduration,(1)unitofservicemaybebilled.Foreachadditionalserviceincrementofatleast15minutes,andadditionalunitofservicemaybebilled,uptoamaximumof(6)unitsperday.

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FZCFernZagorConsultingLLC

ComplexCareManagementComplexCareManagementinbillableinfull5-minuteunits,witha(4)unitmaximum(20minutes).Eachfull5-minuteunitmaybeprovidedonaseparateday(withinthe14-calendarday),withamaximumof(4)full5-minuteunitsassociatedwitheacheligibleclinicvisit.Thisservicedoesnotincludestandardreportwritingorroutinefollowupcalls.Itisnotroutinecaremanagementandmustbemedicallynecessary.Thisservicemustbeprovidedwithin14calendardaysfollowingapsychotherapyservice,psychotropicmedicationtreatmentserviceorcrisisinterventionservice.Itcanprovidebyphoneorinperson.Ifacombinationofpsychotherapy,psychotropicmedicationtreatmentorcrisisserviceoccursonthesameday,Medicaidwillonlyreimburseforupto4unitsofcomplexcarewithin14calendardaysfollowingtheprovisionoftheseservices.TheCCM(ComplexCareManagement)progressnoteshouldclearlydocumenttheintendedimpactofthefollow-upasitrelatestotheclient’smentalhealthstatus.