Insights from Gene Hershorin, MD, based on a newly released episode of REACHing Solutions, a podcast from The REACH Institute.
Time — it’s one of the biggest challenges clinicians face when it comes to addressing patients’ mental health in primary care. With short appointments, lengthy documentation, and countless competing demands, how can clinicians effectively tackle behavioral health concerns?
In a recent episode of REACHing Solutions, developmental-behavioral pediatrician and longtime REACH faculty member Gene Hershorin, MD, shares what he’s learned over nearly two decades of integrating mental health into pediatric practice.
His message is clear: it can be done — and done well.
Not Everything Has to Happen in One Visit
How can pediatric clinicians address mental health within the time they have?
One of Dr. Hershorin’s most practical insights is that you don’t have to solve everything at once.
Unless there’s an urgent safety concern, evaluation and treatment can unfold across multiple visits. For example, a clinician might gather parent history and distribute standardized rating scales at one visit, then schedule a follow-up dedicated to reviewing results and speaking privately with the child.
Standardized rating scales, in particular, can dramatically improve efficiency. They reduce reliance on lengthy narrative updates and allow clinicians to quickly assess symptom change over time.
By spreading components of care across visits and using standardized tools strategically, mental health care becomes more manageable within real-world appointment constraints.
Billing by Time: Making Mental Health Visits Feasible
When approached thoughtfully, behavioral health care does not have to be a financial liability. A major shift for Dr. Hershorin came with changes in evaluation and management (E/M) coding. E/M coding allows clinicians to bill based on total time spent on the day of service including documentation and care coordination. This means clinicians can intentionally schedule longer mental health visits and be appropriately reimbursed for that time.
This strategy makes mental health visits more financially sustainable for clinicians by empowering a practice to deliver comprehensive care without absorbing uncompensated work.
“Learn your billing,” shares Dr. Hershorin. “Or find the person in your practice who really understands it.” Understanding how time-based billing works can fundamentally change how clinicians think about what is possible within a primary care setting.
When a Crisis Interrupts the Schedule
While most mental health care can be structured thoughtfully across visits, crises are the exception to the rule. “If there’s a safety concern, you stop and you address it,” Dr. Hershorin says plainly.
Mental health emergencies — including suicidal ideation — require immediate attention, even if it means adjusting the day’s schedule. Pediatric practices already adapt when a child needs urgent hospitalization for asthma or appendicitis. Mental health crises deserve the same level of flexibility and urgency.
They may disrupt the schedule. But they are part of the responsibility of modern pediatric care.
Want to Hear the Full Conversation?
In the full episode of REACHing Solutions, Dr. Hershorin goes deeper into:
- How to structure mental health visits within short appointment slots
- Practical coding strategies that make the work sustainable
- How to manage suicide risk efficiently and safely
- Concrete steps for building a team-based model, including therapists, psychiatric consultation, and care coordination
- What fully integrated pediatric behavioral health can look like
If you’re wondering how to realistically make time for mental health in your practice, listen now.
To be notified when REACHing Solutions releases new episodes, join our podcast email list.
More Resources:
- Why Clinicians Should Consider Coding by Time for Mental Health Care
- Webinar on Ambulatory Coding Guidelines (2021)
- For those looking to go more in-depth or have a resource on hand, Dr. Hershorin recommends the book Current Procedural Coding Expert (Optum 360).
