An official website of the United States government. The physician completes the age- and gender-appropriate history and exam, including a review of the scores of the screening instruments, and provides counseling/anticipatory guidance and/or identifies the need for diagnostic testing as indicated. 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement ICD-10 codes for routine health examinations (Z00.0-, Z00.1-) should be reported in conjunction with recommended HRAs performed at the same encounter. Billing and Coding: Health and Behavior Assessment/Intervention Save my name, email, and website in this browser for the next time I comment. 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. Documentation of a structured screening or assessment should include the date, patient's name, name and relationship of the informant (when information is provided by someone other than the patient), name of the instrument, score, and name and credentials of the individual administering the instrument. Coding Alert 3: Some payers require reporting 96160 for depression screening other than postpartum depression, even though 96127 is intended for reporting this service, Hughes adds. The CPT codes 96156, 96158, 96159, 96164, 96165, 96167 and 96168 may be used only by a Clinical Psychologist (CP), (Specialty Code 68). Please contact your Medicare Administrative Contractor (MAC). If you are looking for a specific code, use your browser's Find function (Ctrl-F) to quickly locate the code in the article. Copyright 2017 by the American Academy of Family Physicians. Many payers and clearinghouses offer code edit simulators for use in determining whether codes for services such as screenings and assessments are bundled or separately paid. Because the depression screening does not require an interpretation and report, it is not separately paid by this payer. 96160 | Medical Billing and Coding Forum - AAPC A healthcare provider administers a mental health risk assessment questionnaire to a patient experiencing high levels of stress. National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edits do not bundle 96160 and 96161 into the office/outpatient evaluation and management (E/M) codes 99202-99215 (Office or other outpatient visit for the evaluation and management of a new/established patient ) or the preventive medicine E/M codes 99381-99396 (Initial/periodic comprehensive preventive medicine evaluation/reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new/established patient ), and no CPT regulations prohibit the services from being reported together. 2. MACs are Medicare contractors that develop LCDs and Articles along with processing of Medicare claims. The physician reports preventive medicine E/M code 99395 with ICD-10 code Z00.01, Routine adult medical examination with abnormal findings, and F32.1, Major depressive disorder, single episode, moderate. Also reported to the patient's health plan is code 96127 for the depression screening with ICD-10 diagnosis code Z13.89 Encounter for screening for other disorder. If a significant, separately identifiable E/M service was rendered for depression or another health problem, an established patient office or other outpatient service code would be separately reported with modifier 25 appended. This is often included in the test itself, but these elements may alternatively be documented in the progress report of the visit itself. 96160 96161 CPT 96160, Under Health Behavior Assessment and Intervention Procedures The Current Procedural Terminology (CPT ) code 96160 as maintained by American Medical Association, is a medical procedural code under the range - Health Behavior Assessment and Intervention Procedures. Further Clarifications on the Use of 96160 and 96161 Developmental screening performed at the time of a well-child exam is reported with ICD-10 codes Z00.121, Encounter for routine child health examination with abnormal findings, or Z00.129, Encounter for routine child health examination without abnormal findings. If developmental screening is provided at an encounter other than a well-child exam, report code Z13.4, Encounter for screening for certain developmental disorders in children. Watch for payer policies that may require reporting of both codes (Z00.121 or Z00.129 and Z13.4) even though ICD-10 indicates separate codes are not required. These codes do not represent physician work. CPT is a trademark of the American Medical Association (AMA). Here are some hints to help you find more information: 1) Check out the Beneficiary card on the MCD Search page. There are different article types: Articles are often related to an LCD, and the relationship can be seen in the "Associated Documents" section of the Article or the LCD. Medical records need not be submitted with the claim; however, the medical record, (e.g., nursing home record, doctors orders, progress notes, office records, and nursing notes), must be available upon request. Though screening and assessment services require verification of benefits and of coding and documentation requirements, these services may be beneficial to both the patient and the practice. Instrument-based assessment of the caregiver's risk for certain health conditions that may impact his or her ability to care for the patient, Safe Environment for Every Kid, Caregiver Strain Index, and Edinburgh Postnatal Depression Scale (administered for benefit of the child). Health Risk Assessment Codes and How to Use Them When reporting CPT codes 96159, 96165, and 96168, the quantity billed should reflect 1 unit for each 15 minutes. People who have hearing or speech disabilities, please call 711 for relay services. Clinical staff administer and score a structured screening instrument for depression with positive results. CMS believes that the Internet is The healthcare provider discusses the results with the patient and provides recommendations for managing or reducing identified health risks. Report ICD-10 code Z13.89, Encounter for screening for other disorder, in conjunction with depression screening services. In addition, the physician must document that he or she reviewed the score in the context of the patient presentation and discussed the results with the patient/family as part of the related E/M service. This code is used when a healthcare provider administers a standardized questionnaire to a patient to help identify specific health risks, analyzes the results, assigns a score, and documents the findings. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. A few payers do indicate that a report (separate from the E/M service documentation) is required. "CPT Copyright American Medical Association. An asterisk (*) indicates a 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 Adapted from Getting Paid for Screening and Assessment Services.. A patient with a history of smoking completes a lung cancer risk assessment instrument under the guidance of their healthcare provider. an effective method to share Articles that Medicare contractors develop. A score is assigned to the patients health risk based on the assessment instruments criteria. Your information could include a keyword or topic you're interested in; a Local Coverage Determination (LCD) policy or Article ID; or a CPT/HCPCS procedure/billing code or an ICD-10-CM diagnosis code. G0438 - Initial visit. The healthcare provider determines the appropriateness of administering a health risk assessment instrument based on the patients medical history, current health status, and potential risk factors. This blog is not intended to provide medical, financial, or legal advice. The HRA codes 96160 (Administration of patient-focused health risk assessment instrument [eg, health hazard appraisal] with scoring and documentation, per standardized instrument) and 96161 (Administration of caregiver-focused health risk assessment instrument [eg, depression inventory] for the benefit of the patient, with scoring and documentation, per standardized instrument) like all the health behavior assessment and intervention codes (96156-96161) are used to identify and address the psychological, behavioral, emotional, cognitive, and interpersonal factors important to the assessment, treatment, or management of physical health problems, according to CPT guidelines. presented in the material do not necessarily represent the views of the AHA. required field. Code96146, Psychological or neuropsychological test administration, with single automated, standardized instrument via electronic platform, with automated result only, should be reported once per session (CPT Assistant, October 2018). Revenue Codes are equally subject to this coverage determination. All Rights Reserved. Contractors may specify Bill Types to help providers identify those Bill Types typically Coding Guidelines No fee schedules, basic unit, relative values or related listings are included in CPT. All other Codes (ICD-10, Bill Type, and Revenue) have moved to Articles for DME MACs, as they have for the other Local Coverage MAC types. The program covers drugs that are furnished "incident-to" a physician's service provided that the drugs are not "usually self-administered" by the patient. Code 99483 provides reimbursement to physicians and other eligible billing practitioners for a comprehensive clinical visit that results in a written care plan . 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. Example: An 18-month-old established patient is seen for a well-child exam. Reproduced with permission. When 96160 and 96161 are column 1 codes to 96127 and 96110, NCCI considers the column 2 codes as components of the HRA services, though as NCCI assigns the PTP pairs modifier indicators of 1, the edits may be overridden with an NCCI-associated modifier when appropriate. There are multiple ways to create a PDF of a document that you are currently viewing. If you are not billing for these services, you may be losing out on valuable revenue. 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.
Support: +441615131385
Email: info@itc-edu.uk