This code should be used for each standardized survey questionnaire administered, as long as the criteria are established and agreed upon by a group of experts. Reproduced with permission. For instance, Aetna has a long-standing policy to cover depression screening in primary care when the service is performed using the Patient Health Questionnaire-9 (PHQ-9) tool and is reported with code 96127. Please contact the Medicare Administrative Contractor (MAC) who owns the document. Sometimes, a large group can make scrolling thru a document unwieldy. It is conducted through health focused interviews, observations, and clinical decision making. 2022 Transition Coding and Payment Tip Sheet Washington Apple Health means the public health insurance programs for eligible Washington residents. The CPT guidelines for 96156-96161 provide an important reminder about how 96160/96161 differ from two other screening and assessment codes: 96110 (Developmental screening [eg, developmental milestone survey, speech and language delay screen] with scoring and documentation, per standardized instrument) and 96127 (Brief emotional/behavioral assessment with scoring and documentation, per standardized instrument). Developmental surveillance without use of a structured screening instrument is included in the preventive medicine service and not separately reported. Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Additionally, if a similar instrument is administered to a patients caregiver, such as for assessing the patients risk of developing depression, CPT code 96161 should be used instead. Copyright © 2022, the American Hospital Association, Chicago, Illinois. It is the providers responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted. ET), 2023 Annual Clinical & Scientific Meeting, Congressional Leadership Conference (CLC), Coding Question: Postpartum Depression Screening, Alliance for Innovation on Maternal Health, Postpartum Contraceptive Access Initiative. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. The provider documents the assessment instrument used, the patients score, and any related discussions or recommendations in the patients medical record. For Medicare purposes, you also should not bill 96160 separately if furnished as a preventive service, because at that point it would describe a non-covered Medicare service." I ivygirl18@hotmail.com Networker Articles often contain coding or other guidelines that are related to a Local Coverage Determination (LCD). Inpatient prolonged services codes 99356 and 99357 also . Code 96160 is for the patient, who may have risks that impact their health but that have not yet been diagnosed, says, Both 96110 and 96127 reside in the central nervous system assessments/tests code group (96105-96146) and are used to report the services provided during testing of the central nervous system functions, per CPT. CPT Code 96161: Administration of caregiver-focused health risk assessment instrument (e.g., depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument. For the most part, codes are no longer included in the LCD (policy). It begins with a listing of transition-related CPT codes and corresponding Medicare fees and relative value units (RVUs), effective as of 2022. . Recent changes to CPT codes for structured screenings and brief assessments have led some payers to expand coverage for these services. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. How To Use CPT Code 96160 Remaining CPT codes will be required facetoface (more information on later slides). Separate billing for scoring and report preparation is not allowed. G0438 - Initial visit. However, if the physician diagnoses depression, you may report it separately since the global package was valued for uncomplicated antepartum, delivery, and postpartum care. Heres your chance to prove you know your way around the F01-F99 codes. LCD - Health and Behavior Assessment/Intervention (L33834) If you are having an issue like this please contact, You are leaving the CMS MCD and are being redirected to the CMS MCD Archive that contains outdated (No Longer In Effect) Local Coverage Determinations and Articles, You are leaving the CMS MCD and are being redirected to, Billing and Coding: Health and Behavior Assessment/Intervention, AMA CPT / ADA CDT / AHA NUBC Copyright Statement. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). Procedure Coding: Get the Answers to Your Frequently Asked HRA Questions, Get the Answers to Your Frequently Asked HRA Questions, Simply put, the two differ over who is being assessed. PDF CMS Manual System If you dont find the Article you are looking for, contact your MAC. All comments are moderated and will be removed if they violate ourTerms of Use. End Users do not act for or on behalf of the CMS. ICD-10-CM Codes that Support Medical Necessity, ICD-10-CM Codes that DO NOT Support Medical Necessity, L33834 - Health and Behavior Assessment/Intervention, HEALTH BEHAVIOR ASSESSMENT, OR RE-ASSESSMENT (IE, HEALTH-FOCUSED CLINICAL INTERVIEW, BEHAVIORAL OBSERVATIONS, CLINICAL DECISION MAKING), HEALTH BEHAVIOR INTERVENTION, INDIVIDUAL, FACE-TO-FACE; INITIAL 30 MINUTES, HEALTH BEHAVIOR INTERVENTION, INDIVIDUAL, FACE-TO-FACE; EACH ADDITIONAL 15 MINUTES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY SERVICE), ADMINISTRATION OF PATIENT-FOCUSED HEALTH RISK ASSESSMENT INSTRUMENT (EG, HEALTH HAZARD APPRAISAL) WITH SCORING AND DOCUMENTATION, PER STANDARDIZED INSTRUMENT, ADMINISTRATION OF CAREGIVER-FOCUSED HEALTH RISK ASSESSMENT INSTRUMENT (EG, DEPRESSION INVENTORY) FOR THE BENEFIT OF THE PATIENT, WITH SCORING AND DOCUMENTATION, PER STANDARDIZED INSTRUMENT, HEALTH BEHAVIOR INTERVENTION, GROUP (2 OR MORE PATIENTS), FACE-TO-FACE; INITIAL 30 MINUTES, HEALTH BEHAVIOR INTERVENTION, GROUP (2 OR MORE PATIENTS), FACE-TO-FACE; EACH ADDITIONAL 15 MINUTES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY SERVICE), HEALTH BEHAVIOR INTERVENTION, FAMILY (WITH THE PATIENT PRESENT), FACE-TO-FACE; INITIAL 30 MINUTES, HEALTH BEHAVIOR INTERVENTION, FAMILY (WITH THE PATIENT PRESENT), FACE-TO-FACE; EACH ADDITIONAL 15 MINUTES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY SERVICE), Some older versions have been archived. Please contact your Medicare Administrative Contractor (MAC). You, your employees and agents are authorized to use CPT only as agreed upon with the AMA internally within your organization within the United States for the sole use by yourself, employees and agents. Forecasting the future is hard []. Save my name, email, and website in this browser for the next time I comment. Flexibility #6 17 18 An asterisk (*) indicates a Goals and expected duration of specific psychological intervention(s), if recommended. 27) Encounter for routine child health exam with abnormal findings Depression Screening (pg. The CMS.gov Web site currently does not fully support browsers with A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. This test is performed using an electronic platform, such as a computer, and the results of the test are automatically generated. This article describes three steps to seamlessly implement aSBI into your practice: 1) Establish a practice workflow, 2) Incorporate aSBI prompts into your electronic health record (EHR) system, 3). When billing for non-covered services, use the appropriate modifier. Report ICD-10 code Z13.89, Encounter for screening for other disorder, in conjunction with depression screening services. Billing and Coding: Health and Behavior Assessment/Intervention See the CMS . CDT is a trademark of the ADA. Sign up to get the latest information about your choice of CMS topics in your inbox. CPT 96160 is a code used for the administration of patient-focused health risk assessment instruments, including scoring and documentation. For instance, one plan in Tennessee has paid. Article - Billing and Coding: Health and Behavior Assessment/Intervention (A57754). (96160/96161) Codes 99408/99409 cannot be reported for the same patient, on the same date of service, as Health Behavior Assessment . Report code 96161 for a health risk assessment when focused on care-giver risk that may impact the patient's health (e.g., postpartum depression). Coding Alert 2: If your pediatrician also provides an intervention for alcohol or substance abuse, you would report codes 99408 (Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes) and 99409 ( greater than 30 minutes) depending on time, Hughes cautions. required field. What Counts as a Standardized Instrument? Enter the CPT/HCPCS code in the MCD Search and select your state from the drop down. Although an HRA is bundled in the AWV under Medicare Part B, code 96160 may be billed separately in Medicare Advantage plan quality initiatives. All Medicare beneficiaries who are both: Not within 12 months after the effective date of their first Medicare Part B coverage . Use of structured instruments for assessing attention deficit should be linked to the ICD-10 code for the diagnosis or symptoms that prompted the assessment. Are HRAs Bundled Into E/Ms or Other Services? No fee schedules, basic unit, relative values or related listings are included in CPT. A healthcare provider administers a mental health risk assessment questionnaire to a patient experiencing high levels of stress. The CPT codes 96156, 96158, 96159, 96164, 96165, 96167 and 96168 may be used only by a Clinical Psychologist (CP), (Specialty Code 68). Bulk pricing was not found for item. Copyright 2023 American Academy of Family Physicians. Simply put, the two differ over who is being assessed. But you can quickly learn to use screening and assessment codes effectively and accurately. Instructions for enabling "JavaScript" can be found here. *7. A healthcare provider administers a nutrition risk assessment questionnaire to a patient with a history of poor dietary habits. Do your [], Heres your guide to risk-free screening and assessment coding. (See last page for instructions. Documentation in the medical record by the Clinical Psychologist (CP) must include: For the initial assessment, progress notes must include at a minimum the following elements: Onset and history of initial diagnosis of physical illness, and, Clear rationale for why assessment is required, and, Assessment outcome including mental status and ability to understand or respond meaningfully, and. Do You Have What It Takes to Be a Mental Health Coding Maven? Compliance with the provisions in LCD L33834, Health and Behavior Assessment/Intervention may be monitored and addressed through post payment data analysis and subsequent medical review audits.
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