In other words, HRAs identify patients modifiable health risks, which then allows a pediatrician to then provide follow-up behavior change interventions and improve health outcomes, according to the Centers for Disease Control and Prevention (CDC) (Source: https://www.cdc.gov/policy/hst/HRA/FrameworkForHRA.pdf). You must know your specific payer policies. Please enable "JavaScript" and revisit this page or proceed with browsing CMS.gov with 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 It is conducted through health focused interviews, observations, and clinical decision making. 25 However, code 96127 should be reported for both screening and follow-up of. End User Point and Click Amendment: Use for both screening and follow-up of emotional and behavioral health conditions. For the most part, codes are no longer included in the LCD (policy). Sign up to get the latest information about your choice of CMS topics in your inbox. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or HCPCS code G0296 (visit to determine low dose computed tomography (LDCT) eligibility); Current Procedural Terminology (CPT) code 90785 (Interactive Complexity); CPT codes 96160 and 96161 (Health Risk Assessment); HCPCS code G0506 (Care Planning for Chronic Care Management); and CPT codes 90839 and 90840 (Psychotherapy for Crisis). Do your [], Heres your guide to risk-free screening and assessment coding. But you can quickly learn to use screening and assessment codes effectively and accurately. The list of results will include documents which contain the code you entered. No modifier is necessary because the commercial payer does not bundle 96110 with 99392 and allows two units per date of service as the maximum allowable for code 96110. For instance, one plan in Tennessee has paid between $150 and $250 for code 96160 when a specific HRA is completed in conjunction with the IPPE or AWV. Payment policies and claims edits are constantly changing and should be systematically monitored. Remaining CPT codes will be required facetoface (more information on later slides). CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. When more than four CPT codes 96150 are submitted by a provider/group the additional services will be denied. The physician recommends a consultation with a psychologist for management of moderate major depression, and a staff member arranges the appointment for later in the week. Please review and accept the agreements in order to view Medicare Coverage documents, which may include licensed information and codes. Heres your chance to prove you know your way around the F01-F99 codes. Be sure that your billing staff is aware of National Correct Coding Initiative and other payer edits that may bundle or limit the units of service for screening and assessment codes. All Medicare beneficiaries who are both: Not within 12 months after the effective date of their first Medicare Part B coverage . Recent changes to CPT codes for structured screenings and brief assessments have led some payers to expand coverage for these services. Instructions for enabling "JavaScript" can be found here. However, please note that once a group is collapsed, the browser Find function will not find codes in that group. Therefore, if a drug is self-administered by more than 50 percent of Medicare beneficiaries, the drug is excluded from coverage" and the MAC will make no payment for the drug. If you are acting on behalf of an organization, you represent that you are authorized to act on behalf of such organization and that your acceptance of the terms of this agreement creates a legally enforceable obligation of the organization. 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. 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. You can collapse such groups by clicking on the group header to make navigation easier. Your email address will not be published. Code 96161, on the other hand, assesses a caregiver for the patient, not the patient him/herself, when the caregiver may have a condition that is affecting the patient. THE UNITED STATES All Rights Reserved. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). Inpatient prolonged services codes 99356 and 99357 also . All you have to do is learn the answers to these frequently asked questions. DOCUMENTATION GUIDELINES 96110 Each administered developmental screening instrument is accompanied by scoring and documentation (eg, a score or designation as normal or abnormal). There are multiple ways to create a PDF of a document that you are currently viewing. The instrument is scorable. 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. Clinical staff administer and score a structured screening instrument for depression with positive results. When reporting CPT codes 96159, 96165, and 96168, the quantity billed should reflect 1 unit for each 15 minutes. Any questions pertaining to the license or use of the CPT should be addressed to the AMA. Enter the code you're looking for in the "Enter keyword, code, or document ID" box. This article is being retired effective for dates of service on and after 12/08/2022 because the related LCD is being retired. Please contact the Medicare Administrative Contractor (MAC) who owns the document. CMS and its products and services are ICD-10 webpage for individual CRs and coding translations for ICD-10 and . Per CPT, standardized instruments are validated tests that are administered and scored in a consistent or standard manner consistent with their validation. For 96160, that would include such tests as the Mini Nutritional Assessment-Short Form; Sport Concussion Assessment Tool (SCAT 5-); Alcohol Use Disorders Identification Test; Care, Relax, Alone, Forget, Friends, Trouble (CRAFFT); and Home, Education, Eating, Activities, Drugs and Alcohol, Suicide and Depression Sexuality and Safety (HEEADSSS), while standardized tests appropriate for 96161 include the Safe Environment for Every Kid; Caregiver Strain Index; and Edinburgh Postnatal Depression Scale, according to Cindy Hughes, CPC, CFPC, consulting editor of Cindy Hughes Consulting in El Dorado, Kansas. Although the fee-for-service payment for screening and assessments may be small, it can add up to significant income across a patient panel. Be aware that some payers will only reimburse psychologists and psychiatrists for treating depression. Response to Comment (RTC) articles list issues raised by external stakeholders during the Proposed LCD comment period. In most instances Revenue Codes are purely advisory. All Rights Reserved. The following CPT codes associated with the services outlined in this Billing and Coding Article will not have diagnosis code limitations applied at this time. accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the Please do not use this feature to contact CMS. See the CMS . Self-Administered Drug (SAD) Exclusion List articles list the CPT/HCPCS codes that are excluded from coverage under this category. Separate billing for scoring and report preparation is not allowed. Reproduced with permission. ICD-10 codes for routine health examinations (Z00.0-, Z00.1-) should be reported in conjunction with recommended HRAs performed at the same encounter. Please try reloading page. . Local Coverage Articles are a type of educational document published by the Medicare Administrative Contractors (MACs). Code 96160 is for the patient, who may have risks that impact their health but that have not yet been diagnosed, says Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington. CPT 96160 is a code used for the administration of patient-focused health risk assessment instruments, including scoring and documentation. Health and behavioral assessment is an evaluation of psychological, behavioral, emotional, cognitive and social factors that affect the patients response. Unless specified in the article, services reported under other For patients who require psychiatry services or adaptive behavior services as well as health and behavior assessment and intervention (CPT codes 96156, 96158, 96159, 96164, 96165, 96167 and 96168), report the predominant service performed. Look for a Billing and Coding Article in the results and open it. Adapted from Getting Paid for Screening and Assessment Services.. 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. ). It is worth the effort to determine which payers in your area pay for these services. descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work Example A: An adult established patient with opioid addiction, currently in remission, is seen for a routine physical examination. The official description of CPT code 96160 is: Administration of patient-focused health risk assessment instrument (e.g., health hazard appraisal) with scoring and documentation, per standardized instrument..
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