RESOURCES FOR CHAPLAINS
It is vital for chaplains and chaplaincy department managers to understand the importance of the chaplain services HCPCS codes and to begin including them in patient documentation as soon as they are available in their organization’s Electronic Medical Record (EMR). The following sections provide basic information for chaplains and their managers, plus a link to a training resource developed by the Spiritual Care Association.
What Are The CMS Chaplain Services Codes?
Physicians and other medical care providers use a system of ICD-10 codes (International Classification of Diseases, Tenth Revision) for the diagnosis of diseases. This medical classification list developed, updated, and owned by the World Health Organization (WHO) contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. These codes are used by healthcare systems worldwide.
The Centers for Medicare & Medicaid Services (CMS), a federal agency within the United States Department of Health and Human Services, maintains another set of codes that are used to classify medical services and procedures in the United States. The Healthcare Common Procedure Coding System (HCPCS) is made up of two levels: Level I codes are the Current Procedural Terminology (CPT) codes, which are maintained by the American Medical Association (AMA). These codes describe medical procedures and services provided by healthcare professionals, such as doctors and nurses. Level II codes are the HCPCS codes proper, which are maintained by CMS. These codes describe medical supplies, equipment, and other services that are not covered by CPT codes.
Prior to October 1, 2022, the only HCPCS codes approved for chaplain services were for use in the Department of Veteran Affairs (VA) System.* As of October 2022, after successful lobbying by several interested organizations, CMS revised the narrative code descriptions related to chaplaincy services to allow for use outside the VA System. The three revised codes are:
- Q9001 Assessment by chaplain services
- Q9002 Counseling, individual, by chaplain services
- Q9003 Counseling, group, by chaplain services
What does the letter Q mean?
These HCPCS Level II codes are designated by the letter “Q.” CMS assigns Q codes to procedures, services, and supplies on a temporary basis, often for new modalities of care not currently identified in other HCPCS codes. When a permanent code is assigned in the future, the Q code is deleted and cross-referenced.
Codes in this code set (Q codes) are not typically assigned by coders within a health care organization. More commonly, Q codes are included in a hospital’s charge description master (or chargemaster as it is often called). This is a list of all the services and items provided to patients in a facility, whether billable or not. This system allows the chaplain to select the appropriate Q code within the EMR documentation to ensure that the code is captured within the organization’s reporting system of patient care services provided.
*An exception to this is a special HCPCS “G” code in use prior to the VA codes implementation. G9473 is a code that designates services performed by a chaplain in the hospice setting, in 15 minute increments. Hospice chaplains use G codes to report a beneficiary’s functional limitation being treated and note whether the report is on the beneficiary’s current status, projected goal status, or discharge status.
Why Are The CMS Chaplain Services Codes Important?
HCPCS codes are important in health care for a number of reasons. First, they ensure that medical procedures and services are accurately and consistently described across the health care industry. Second, HCPCS codes can be used to track and analyze health care trends and outcomes. Researchers and policymakers can use this data to improve health care quality and effectiveness. Finally, HCPCS codes are used to determine reimbursement rates for health care services. Insurance companies and government agencies use these codes to calculate how much they will pay for specific procedures and services.
Support integration of chaplaincy in health care
For many years, professional health care chaplains have been recognized as the spiritual care leaders on the health care team responsible for assessing and meeting the spiritual, religious, and existential needs of patients, loved ones, and staff. Despite this recognition, the integration of spiritual care and chaplaincy care has lagged. One of the major reasons for this lag in full integration has been a lack of standardized measures that would allow researchers to determine what chaplains do, how much of it they do, and what impact they have on health care outcomes. The chaplain services codes now make the standardized recording and reporting of that data possible.
Other clinicians use HCPCS codes
Historically, chaplaincy has been excluded from the HCPCS data tracking system. With the introduction of these chaplain services codes, chaplains will now be on an equal footing with other health care professionals in recording the clinical work in which they engage. While these codes will not be used at present to provide revenue to an organization for chaplain services provided, they do give chaplains visibility for their contributions to a patient’s overall care through spiritual assessment (Q9001), individual spiritual counseling (Q9002), and group spiritual counseling (Q9003).
Important for new healthcare drivers
These codes will also allow the reporting and measurement of chaplaincy’s contribution to newer health care drivers such as accountable care and health equity. By having them in an institutional EMR, multiple correlations will be possible to establish the relationship between chaplaincy visits, assessments, and outcomes including length of stay, site of death, and patient satisfaction scores.
How Do Chaplains Use The Codes?
Use this code whenever a chaplain performs and documents a comprehensive spiritual assessment of a patient during a visit. For encounters that do not meet this code’s criteria, use the individual counseling code Q9002 for a visit with an individual patient or Q9003 for an encounter with a group of patients, even if this is an initial encounter.
Q9001 Assessment by chaplain services
- Assessment includes spiritual, religious, existential (S/R/E) history, identifying S/R/E concerns and resources, the level and nature of spiritual distress, and the impact of S/R/E issues/resources on the patient’s coping, their health status, and their receipt of health services. Recommendations for addressing S/R/E issues in patient care should be included.
- Use comprehensive and evidence-based spiritual assessment models/tools. Examples of these include the 7x7 model and the Spiritual AIM model.
- Documentation and chart review are included in this code and may not be coded separately.
Required elements for documentation:
- Relevant spiritual, religious, existential history and practices and their importance.
- Current S/R/E concerns/needs, resources, and practices and their impact on coping with illness and health status.
- The level and nature of spiritual distress.
- Recommendations for addressing S/R/E issues in patient care.
- Relevant family, social, community, and developmental factors impacting the patient’s coping and health (e.g., family and social dynamics, community resources/needs, and developmental history), where applicable.
- Assessment of pertinent emotional state(s)/expressions or state of mind including suicidal/homicidal ideation where applicable.
- Care plan or treatment plan, including the frequency and nature/types of chaplaincy services/interventions needed for ongoing care/treatment as appropriate.
- If counseling is planned, the documentation should indicate that the patient consents to and is able to participate in and benefit from counseling.
- Anticipated treatment duration (interval), where applicable.
Use this code for any visit with an individual that does not include a spiritual assessment. Use the code for an initial encounter without spiritual assessment or a follow up visit with an established patient, including a bereavement visit.
Q9002 Counseling, Individual, by chaplain services
- Counseling of others related to the patient can be included if the encounter would normally be included in documentation and the interactions are separate from the visit with the patient.
- Documentation and chart review are included in this code and may not be coded separately.
- Counseling of staff is not included with this code.
Required elements for documentation:
- Reason for encounter.
- Currently acute and relevant S/R/E concerns/needs and resources and their impact on coping with illness and health status (as presented in the encounter).
- The current level and nature of spiritual distress (as presented in the encounter).
- Appropriate high-risk factors (such as suicidal/homicidal ideation) where applicable.
- Chaplaincy interventions and their outcomes/impact should be explicitly stated.
- Using published taxonomies or established/consensus-based terminology for describing chaplaincy interventions is highly recommended.
- Listing interventions should be limited to a few most important/impactful interventions that were most helpful/useful to the care recipient.
- Recommendations for addressing S/R/E issues in patient care.
- Changes in treatment plan when appropriate, indicating the frequency and nature/types of chaplaincy services/interventions needed for ongoing care/treatment.
- Time spent.
Use this code for any established patient in a chaplain-led group discussion, including bereavement.
Q9003 Counseling, Group, by chaplain services
- Documentation and chart review are included in this code and may not be coded separately.
- Documentation must be present in each patient’s health record.
Required elements for documentation:
- Reason for encounter and the goal(s) of group counseling.
- Currently acute and relevant S/R/E concerns/needs and resources and their impact on coping with illness and health status (as presented in the encounter).
- The current level and nature of spiritual distress (as presented in the encounter).
- Appropriate high-risk factors (such as suicidal/homicidal ideation) where applicable.
- Chaplaincy interventions and their outcomes/impact should be explicitly stated.
- Using published taxonomies or established/consensus-based terminology for describing chaplaincy interventions is highly recommended.
- Listing interventions should be limited to a few most important/impactful interventions that were most helpful/useful to the care recipient.
- Recommendations for addressing S/R/E issues in patient care.
- Changes in treatment plan when appropriate, indicating the frequency and nature/types of chaplaincy services/interventions needed for ongoing care/treatment.
- Time spent.
Note that the wording of the code descriptions themselves was set by CMS and must be used as written for proper coding. “Q9001 Assessment by chaplain services” is straightforward and will be readily understood by all chaplains. The use of the terms “counseling” in the other two chaplain services codes – “Q9002 Counseling, Individual, by chaplain services” and “Q9003 Counseling, Group, by chaplain services” may seems less obvious to chaplains but must be used as written. How did these terms come to be?
Some years ago, chaplains from the U.S. Department of Veterans Affairs (VA) mounted a successful effort that resulted in three codes for recording the work of health care chaplains, but only in the VA health care system. Those codes were:
- Q9001 Assessment by Department of VA Chaplain Services
- Q9002 Counseling, Individual, by Department of VA Chaplain Services
- Q9003 Counseling, Group, by Department of VA Chaplain Services
The naming convention adopted reflected the familiar HCPCS codes already in use by therapists and other clinicians at the VA who performed detailed assessments on patients as well as individual and group counseling sessions.
After two years of unsuccessful lobbying by HCCN and partners, in October 2022 CMS finally agreed to allow those Q codes to apply to all chaplains in health care, using the VA wording but without the reference to the VA. Keeping the wording of the codes as close to the original as possible made it much more likely that CMS would approve the HCCN version requested. This is why the new codes are the same as the original ones but with “Department of VA” removed. For the full CMS report on the proceedings that led to this adoption, see pp. 168-173 of the official CMS publication accessible here.
How Do Chaplains Use The Codes?
This section contains code descriptions developed by a team of health care chaplains led by Transforming Chaplaincy and HealthCare Chaplaincy Network and building on descriptions already in use by the Veterans Health Administration. They are meant to guide implementation of these codes throughout US health care. Codes should be applied in all settings of care including virtual/telehealth visits or groups. Note that the wording of the codes themselves was set by CMS and must be used as written for proper coding.
Use this code whenever a chaplain performs and documents a comprehensive spiritual assessment of a patient during a visit. For encounters that do not meet this code’s criteria, use the individual counseling code Q9002 for a visit with an individual patient or Q9003 for an encounter with a group of patients, even if this is an initial encounter.
Q9001 Assessment by chaplain services
- Assessment includes spiritual, religious, existential (S/R/E) history, identifying S/R/E concerns and resources, the level and nature of spiritual distress, and the impact of S/R/E issues/resources on the patient’s coping, their health status, and their receipt of health services. Recommendations for addressing S/R/E issues in patient care should be included.
- Use comprehensive and evidence-based spiritual assessment models/tools. Examples of these include the 7x7 model and the Spiritual AIM model.
- Documentation and chart review are included in this code and may not be coded separately.
Required elements for documentation:
- Relevant spiritual, religious, existential history and practices and their importance.
- Current S/R/E concerns/needs, resources, and practices and their impact on coping with illness and health status.
- The level and nature of spiritual distress.
- Recommendations for addressing S/R/E issues in patient care.
- Relevant family, social, community, and developmental factors impacting the patient’s coping and health (e.g., family and social dynamics, community resources/needs, and developmental history), where applicable.
- Assessment of pertinent emotional state(s)/expressions or state of mind including suicidal/homicidal ideation where applicable.
- Care plan or treatment plan, including the frequency and nature/types of chaplaincy services/interventions needed for ongoing care/treatment as appropriate.
- If counseling is planned, the documentation should indicate that the patient consents to and is able to participate in and benefit from counseling.
- Anticipated treatment duration (interval), where applicable.
Use this code for any visit with an individual that does not include a spiritual assessment. Use the code for an initial encounter without spiritual assessment or a follow up visit with an established patient, including a bereavement visit.
Q9002 Counseling, Individual, by chaplain services
- Counseling of others related to the patient can be included if the encounter would normally be included in documentation and the interactions are separate from the visit with the patient.
- Documentation and chart review are included in this code and may not be coded separately.
- Counseling of staff is not included with this code.
Required elements for documentation:
- Reason for encounter.
- Currently acute and relevant S/R/E concerns/needs and resources and their impact on coping with illness and health status (as presented in the encounter).
- The current level and nature of spiritual distress (as presented in the encounter).
- Appropriate high-risk factors (such as suicidal/homicidal ideation) where applicable.
- Chaplaincy interventions and their outcomes/impact should be explicitly stated.
- Using published taxonomies or established/consensus-based terminology for describing chaplaincy interventions is highly recommended.
- Listing interventions should be limited to a few most important/impactful interventions that were most helpful/useful to the care recipient.
- Recommendations for addressing S/R/E issues in patient care.
- Changes in treatment plan when appropriate, indicating the frequency and nature/types of chaplaincy services/interventions needed for ongoing care/treatment.
- Time spent.
Use this code for any established patient in a chaplain-led group discussion, including bereavement.
Q9003 Counseling, Group, by chaplain services
- Documentation and chart review are included in this code and may not be coded separately.
- Documentation must be present in each patient’s health record.
Required elements for documentation:
- Reason for encounter and the goal(s) of group counseling.
- Currently acute and relevant S/R/E concerns/needs and resources and their impact on coping with illness and health status (as presented in the encounter).
- The current level and nature of spiritual distress (as presented in the encounter).
- Appropriate high-risk factors (such as suicidal/homicidal ideation) where applicable.
- Chaplaincy interventions and their outcomes/impact should be explicitly stated.
- Using published taxonomies or established/consensus-based terminology for describing chaplaincy interventions is highly recommended.
- Listing interventions should be limited to a few most important/impactful interventions that were most helpful/useful to the care recipient.
- Recommendations for addressing S/R/E issues in patient care.
- Changes in treatment plan when appropriate, indicating the frequency and nature/types of chaplaincy services/interventions needed for ongoing care/treatment.
- Time spent.
How Will These Codes Be Implemented?
For many years, professional health care chaplains have been recognized as the spiritual care leaders on the health care team responsible for assessing and meeting the spiritual, religious, and existential needs of patients and their loved ones, and the staff who care for them. Health care administrators have long valued the role that chaplaincy plays in the spiritual and emotional life of their institutions. Despite this recognition, the integration of spiritual and chaplaincy care as integral to whole person care has lagged. One of the major reasons for this lag has been a lack of standardized measures that allow researchers to determine what chaplains do, how much of it they do, and what impact they have on health care outcomes.
The HCPCS chaplain services codes now make the standardized recording and reporting of that data possible. To support this effort, chaplains and their managers who want to implement these codes in their institution will need to plan, advocate, and commit to the discipline of using them consistently in documenting chaplain/patient encounters in all health care settings.
Planning
Both staff chaplains and chaplaincy department managers must plan how and when they will begin using the chaplain services codes.
Staff chaplains must be willing to begin using the correct code each time they document a patient encounter in the EMR. They are not being asked to change their practice as chaplains and spiritual care providers, but they are being asked to include the codes in their documentation each time they perform a spiritual assessment, make a routine individual patient visit, or engage in group patient encounters. By using the codes, chaplains will finally be incorporated into the health care system with better visibility and credit for the important work they are doing.
Chaplaincy managers are in the unique position of being responsible downstream for the quality of spiritual care provided by the staff chaplains they manage and upstream to administration in a rapidly changing health care environment. Downstream, they must become champions for using the codes with their staff, scheduling training for their chaplains on the correct use of the codes, and ensuring quality and compliance through chart reviews and reports. Upstream, they must be able to articulate the value of chaplaincy to their healthcare leaders and demonstrate why spiritual care is an essential component of quality patient care services. To support this endeavor, chaplaincy managers will find that the upfront investment in time and effort to integrate the codes into chaplaincy documentation within the EMR will reap long-term benefits in ease of gathering, reporting, and analyzing data for the institution where they work.
Advocating
In most health care organizations, the EMR will be automatically updated with the chaplain services codes along with other regular system updates. Often this happens in scheduled annual or biannual updates, but they may also be made available by the EMR vendor at other times.
To ensure the codes become accessible for use once they are available, chaplains and their managers must navigate the institutional framework and advocate with important constituents within their organization for these new ways to record and measure the effects of chaplaincy care.
A good place to start is by organizing meetings with representatives from IT, billing and coding, quality improvement, reporting and analysis, and other stakeholders who typically oversee the functions of the EMR that help the institution advance its mission. Begin by sharing the information published here and by other trusted sources about the codes and their importance in reporting and measuring the contribution of chaplaincy and spiritual/religious/existential care to patient care and health outcomes. To demonstrate the advantages of research-informed spiritual care, it may be helpful to distribute publications that show correlations between spiritual/chaplaincy care and patient health outcomes. Some examples are listed below. For those functions within health care focused on decision making, data tracking, measurement against performance and financial goals, etc., the benefit of supporting the use of the chaplain services codes is that they represent the first step in incorporating chaplaincy as a health care profession with visibility and accountability within the EMR.
Commitment
The key to successful implementation and use of the chaplain services codes is commitment. One value of HCPCS codes in general is that they can be used to track and analyze health care trends and outcomes. Researchers and policymakers already use this data to improve quality and effectiveness in many clinical and professional arenas of health care. Now for the first time, chaplaincy as a profession has a standardized way to participate in these measures.
It is critical to standardize the implementation and use of these codes across the U.S. so that they can yield maximum benefit for budgeting and quality improvement. These codes will also allow the reporting and measurement of chaplaincy’s contribution to newer health care drivers such as accountable care and health equity. By having them in an institutional EMR, multiple correlations will be possible to establish the relationship between chaplaincy visits, assessments, and outcomes including length of stay, site of death, and patient satisfaction scores.
Once the codes have been incorporated into major EMR systems, have been implemented by administration and embraced by staff chaplains through the diligent work of chaplaincy managers, then the profession of chaplaincy will have the opportunity to aggregate, analyze, and report on consistent data not only across multiple chaplains and multiple service lines, but across multiple entities nationally.
Helpful resources
The publications listed here may be helpful in supporting chaplains’ advocacy for a full and timely deployment of the chaplain services codes within their organization.
- Spiritual Care: What it Means, Why it Matters in Healthcare
https://www.spiritualcareassociation.org/foundational-papers/
- Relationship Between Chaplain Visits and Patient Satisfaction
http://dx.doi.org/10.1080/08854726.2014.981417
- Support of cancer patients’ spiritual needs and associations with medical care costs at the end of life
https://acsjournals.onlinelibrary.wiley.com/doi/10.1002/cncr.26221
- Provision of Spiritual Care to Patients with Advanced Cancer: Associations With Medical Care and Quality of Life Near Death
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2815706/
- Relationship Between Religion/Spirituality and the Aggressiveness of Cancer Care: A Scoping Review
A Note on Implementation for Epic Users
In late 2023, Epic Systems, a leading vendor of Epic electronic health record software, included the CMS Chaplain codes in their Foundation System. Typically, these codes will be put into the Charge Capture Navigator section. Chaplains should work with their IT team to determine how their organization plans to implement the codes and where to access them in their Epic system. Many organizations will choose to build these codes into a Preference List for chaplains to select from, but it is up to each organization’s chaplaincy department and IT team to determine whether that is the preferred workflow. Chaplains who use Epic for their patient charting are encouraged to begin the process by submitting a ticket to IT asking about the codes and their availability.
Understanding CMS Codes for Clinical Chaplaincy
SCA has developed a training course called Understanding CMS Codes for Clinical Chaplaincy that provides information and guidance for chaplains and chaplaincy managers seeking to understand and implement the CMS chaplain services codes. This course provides an overview of all pertinent issues with links to more in-depth education available at the SCA’s extensive Learning Center. The course can be completed in approximately 10 hours of study. A certificate of completion can be printed on successful completion. For more information and to take the course, click here.