Commentary: health & behavior codes: great idea, questionable outcome.

Operating a successful pediatric psychology service in a hospital setting requires attention to three primary domains of professional practice: the clinical, operational, and financial (Kessler, 2008). Even an optimally provided service in the clinical and operational domains is unlikely to be sustainable if not also financially viable. One major challenge to financial viability is that overhead expenses charged to pediatric psychology services are typically similar to charges made to medical services, which receive considerably more money per unit of service and thus generate significantly more revenue. This disparity in income potential has contributed to placing considerable financial pressure and time demands on providers of hospital-based pediatric psychology services. The financial challenges associated with the successful practice of pediatric psychology in hospital settings highlights the importance of optimizing billing practices as a necessary component of sustainable practice. Providing behavioral health services to patients with primary medical conditions has been demonstrated as an an important aspect of medical care, but can only become a standard of care when psychologists are adequately compensated for providing the service. In this commentary, we briefly review the potential economic benefits of using Health and Behavior (H&B) codes, describe the use of these codes in our practice, and discuss current pragmatic barriers and problems associated with their use.