25 PDF Coding & Billing Guidance Document This code may also be reported for depression screening in adult patients other than Medicare beneficiaries. HCPCS/CPT Codes. However, some payers may reimburse for this service. 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. Health and behavioral assessment is an evaluation of psychological, behavioral, emotional, cognitive and social factors that affect the patients response. The requirements to report either 96160 or 96161 are as follows: Practice expense is incurred to administer the instrument (such as nurse time or for purchase of the screen). Separate billing for scoring and report preparation is not allowed. Billing and Coding articles provide guidance for the related Local Coverage Determination (LCD) and assist providers in submitting correct claims for payment. Several scenarios require use of a modifier when billing for screening and assessment services, including the following: Modifier 25 may be required to indicate a significant, separately identifiable preventive or other E/M service was provided on the same date. This test is performed using an electronic platform, such as a computer, and the results of the test are automatically generated. The effective date of this revision is based on date of service. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or This Agreement will terminate upon notice if you violate its terms. 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. All documentation must be maintained in the patient's medical record and made available to the contractor upon request. The effective date of this . of the Medicare program. Organizations who contract with CMS acknowledge that they may have a commercial CDT license with the ADA, and that use of CDT codes as permitted herein for the administration of CMS programs does not extend to any other programs or services the organization may administer and royalties dues for the use of the CDT codes are governed by their commercial license. The list of results will include documents which contain the code you entered. G0438 - Initial visit. To see a description of each code and examples of standardized instruments that may be used for each, see Quick reference: Screening and assessment codes. CPT Assistant has described a standardized instrument as a previously validated test that is administered and scored in a consistent or standard manner. Validated structured instruments have been shown through study to provide consistent and reliable results. 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 Washington Apple Health means the public health insurance programs for eligible Washington residents. How To Use CPT Code 96160 ICD-10 Codes. AHA copyrighted materials including the UB‐04 codes and You can use the Contents side panel to help navigate the various sections. Yes, a claim must be submitted with Current Procedural Terminology (CPT) code 96160 in conjunction and on the same claim with the appropriate office visit, evaluation and management code (E/M) or Annual Wellness Visit code indicating a face-to-face visit occurred. The page could not be loaded. This article will cover topics such as the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 96160 procedures. 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. Five similar codes to CPT 96160 and how they differentiate are: Here are 10 detailed examples of CPT code 96160 procedures: Your email address will not be published. Please note that for 2019 ICD-10 codes, category F53, Puerperal psychosis, was revised to include two new codes:F53.0, Postpartum depression;and F53.1, Puerperal psychosis. Depression screening, reported with 96127, is typically a covered preventive service for adolescents age 12 to 18 and is a quality measure in many pediatric quality initiatives. CMS has defined "not usually self-administered" according to how the Medicare population as a whole uses the drug, not how an individual patient or physician may choose to use a particular drug. Another option is to use the Download button at the top right of the document view pages (for certain document types). Try using the MCD Search to find what you're looking for. Because the depression screening does not require an interpretation and report, it is not separately paid by this payer. CPT is a registered trademark of the American Medical Association.". It is worth the effort to determine which payers in your area pay for these services. 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). You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. All rights reserved. Instrument-based assessment of potential emotional and/or behavioral problems (e.g., depression, attention-deficit), Patient Health Questionnaire-9, Edinburgh Postnatal Depression Scale (administered for the benefit of the mother), and NICHQ Vanderbilt Assessment Scales. There have been no updates to the code since its addition. Do not reportCPT codes 96156, 96158, 96159, 96164, 96165, 96167 and 96168 in addition to codes for psychiatry services on the same date. accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the See permissionsforcopyrightquestions and/or permission requests. The submitted CPT/HCPCS code must describe the service performed. The following CPT codes are not applicable for developmental delay screening or testing: 96160, 96161, 99411, 99412, 99429. Please contact your Medicare Administrative Contractor (MAC). . 2) Try using the MCD Search and enter your information in the "Enter keyword, code, or document ID" box. THE UNITED STATES If you are experiencing any technical issues related to the search, selecting the 'OK' button to reset the search data should resolve your issues. PDF Coding & Billing Guide December 2018 Updates - NCDHHS Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service [s]). 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. 7500 Security Boulevard, Baltimore, MD 21244. Coding Alert 1: Some payers require reporting 96127 for HEEADSSS and CRAFFT screenings, Hughes notes. Code G0444 should be reported to Medicare Part B administrative contractors for this purpose instead of code 96127, and the time spent on screening and discussing results and recommendations should be documented. Coding Question: Postpartum Depression Screening | ACOG Physicians should check with their specific payers. But some brief assessment instruments such as the Epworth Sleepiness Scale may be considered an HRA by some payers but bundled with a diagnostic E/M service by others, Hughes cautions. See the CMS . Sign up to get the latest information about your choice of CMS topics in your inbox. If your session expires, you will lose all items in your basket and any active searches. CPT 96161: This code is used for the administration of a caregiver-focused health risk assessment instrument, such as a depression inventory, for the benefit of the patient. In addition, most are recommended preventive services, and some may also be factored into performance ratings and quality initiatives. All rights reserved. or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 For example, the assessment might be done on a new mother to see if there is any problem, such as postpartum depression, that could affect the care of the patient, Bucknam adds. 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. You must know your specific payer policies. Example A: An adult established patient with opioid addiction, currently in remission, is seen for a routine physical examination. You can use your browser's Print function (Ctrl-P on a PC or Command-P on a Mac) to view a print preview and then select PDF as the output. descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work Child Development/Developmental Monitoring and Screening. Reproduced with permission. 4) Visit Medicare.gov or call 1-800-Medicare. Simply put, the two differ over who is being assessed. 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. 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 patients responses to the questionnaire. For assessments of specific risks such as caregiver strain, report code Z13.89. The instrument is scorable. The CPT codes 96156, 96158, 96159, 96164, 96165, 96167 and 96168 may be used only by a Clinical Psychologist (CP), (Specialty Code 68). Four screening codes you should be using | AAFP Applicable FARS\DFARS Restrictions Apply to Government Use. Codes 96160-96161 are reported in addition to the evaluation and management (E/M) code (eg, 99213). Neither the United States Government nor its employees represent that use of such information, product, or processes Billing and Coding: Health and Behavior Assessment/Intervention The healthcare provider discusses the results with the patient and provides recommendations for managing or reducing identified health risks. DOCUMENTATION GUIDELINES Each administered developmental screening and testing instrument is accompanied by an interpretation and report (eg, a score or designation as normal or abnormal). Some articles contain a large number of codes. 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. The views and/or positions Was your Medicare claim denied? An annual depression screening of up to 15 minutes is covered for Medicare beneficiaries in primary care settings that have staff-assisted depression care supports in place to assure accurate diagnosis, effective treatment, and follow-up. (Or, for DME MACs only, look for an LCD.) 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). CMS and its products and services are not endorsed by the AHA or any of its affiliates. CPT 96160 is a code used for the administration of patient-focused health risk assessment instruments, including scoring and documentation. CPT 96138: This code is used for the administration and scoring of psychological or neuropsychological tests by a technician. Look for a Billing and Coding Article in the results and open it. License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, AMA Plaza 330 N. Wabash Ave., Suite 39300, Chicago, IL 60611-5885. This First Coast Billing and Coding Article for Local Coverage Determination (LCD) L33834 Health and Behavior Assessment/Intervention provides billing and coding guidance for frequency limitations as well as diagnosis limitations that support diagnosis to procedure code automated denials. Via Non-Standardized Instrument or Assessment If SDOH risk factors are determined by use of a non-standardized instrument or assessment, CPT codes 96160 or 96161 cannot be reported. 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. For additional quantities, please contact [emailprotected] Please contact the Medicare Administrative Contractor (MAC) who owns the document. This email will be sent from you to the Key CPT and Medicare Changes for Family Medicine in 2022 If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. 2. The views and/or positions presented in the material do not necessarily represent the views of the AHA. NCDs do not contain claims processing information like diagnosis or procedure codes nor do they give instructions to the provider on how to bill Medicare for the service or item. Medicaid reimburses providers for CPT code 96160 to a maximum of two units per visit. How to bill for brief substance and alcohol abuse services 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. MLN6775421 - Medicare Wellness Visits - Centers for Medicare Please try reloading page. 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). American College of Obstetricians and Gynecologists A neuropsychologist is completing a neuropsychological evaluation. Although the fee-for-service payment for screening and assessments may be small, it can add up to significant income across a patient panel. Health and behavioral intervention is the promotion of functional improvements in the patients psychological and psychosocial condition. Payment policies and claims edits are constantly changing and should be systematically monitored. ICD-10 webpage for individual CRs and coding translations for ICD-10 and . The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. Any follow-up appointments or referrals made based on the assessment results. 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). "JavaScript" disabled. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. End User Point and Click Amendment:

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