If you would like to extend your session, you may select the Continue Button. For assessments of specific risks such as caregiver strain, report code Z13.89. Use for developmental and autism screening. Any questions pertaining to the license or use of the CPT should be addressed to the AMA. Complete absence of all Revenue Codes indicates For purpose of this exclusion, "the term 'usually' means more than 50 percent of the time for all Medicare beneficiaries who use the drug. Response to Comment (RTC) articles list issues raised by external stakeholders during the Proposed LCD comment period. 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. Further Clarifications on the Use of 96160 and 96161 Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. 21) The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Only the preventive medicine E/M service code, reported with ICD-10 codes Z00.01, F32.1, and Z13.89, is reimbursed. In order for CMS to change billing and claims processing systems to accommodate the coverage conditions within the NCD, we instruct contractors and system maintainers to modify the claims processing systems at the national or local level through CR Transmittals. While every effort has been made to provide accurate and Instructions for enabling "JavaScript" can be found here. 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. If that doesnt work please contact, Technical issues include things such as a link is broken, a report fails to run, a page is not displaying correctly, a search is taking an unexpectedly long time to complete. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be Quality initiatives that include incentives for performing and reporting recommended screenings and assessments are an additional reason to familiarize yourself with these four codes: 96110, Developmental screening (e.g., developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument,, 96127, Brief emotional/behavioral assessment (e.g., depression inventory, attention-deficit/hyperactivity disorder scale), with scoring and documentation, per standardized instrument,, 96160, Administration of patient-focused health risk assessment instrument (e.g., health hazard appraisal) with scoring and documentation, per standardized instrument,, 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.. The document is broken into multiple sections. Applications are available at the American Dental Association web site. ICD-10 CM diagnosis code(s) reflecting the physical condition(s) being treated must be present on the claim as the primary diagnosis. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). Once youve answered the quiz [], Test Your Understanding of This MDM Element, Question: In the answer to question 2 in Take This Quiz, See if Your 2021 [], Choose These Codes for Post-COVID Sports Clearance, Question:Our pediatric office wants to put together a procedure for clearing patients post-COVID infections for [], Know These Requirements Before Billing Non-Face-to-Face Prolonged Services, Question: I know that 99358 is a standalone code that requires at least 30 minutes [], Rule in These Codes When Suspected Substance Symptoms Ruled Out, Question: If Mom smoked tobacco or abused substances during pregnancy, and the newborn does not [], Copyright 2023. 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. 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. Specifically, CPT code 96160 describes the administration of patient-focused health risk assessment instruments with scoring and documentation, per standardized instrument. Enter the CPT/HCPCS code in the MCD Search and select your state from the drop down. If you need more information on coverage, contact the Medicare Administrative Contractor (MAC) who published the document. The instrument is standardized. Article document IDs begin with the letter "A" (e.g., A12345). Forecasting the future is hard []. G0439 - Subsequent visit. Explanation of Revision: Annual 2020 HCPCS Update. Payment policies and claims edits are constantly changing and should be systematically monitored. Simply put, the two differ over who is being assessed. Applicable FARS\DFARS Restrictions Apply to Government Use. 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. 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). Modifier 33 may be required to indicate a service that may be preventive or diagnostic was provided as a preventive service. 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). A few payers do indicate that a report (separate from the E/M service documentation) is required. How Do 96160/96161 Differ From Other Screening and Assessment Codes? A patient with a family history of osteoporosis completes a bone health risk assessment instrument. Do You Have What It Takes to Be a Mental Health Coding Maven? Please contact your Medicare Administrative Contractor (MAC). and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only However, code 96127 should be reported for both screening and follow-up of emotional and behavioral health conditions. CPT codes 96156, 95158, 96159, 96164, 96165, 96167, and 96168 were added. During the PHE, outpatient psychiatric service facetoface requirements were waived. 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. s an evaluation of psychological, behavioral, emotional, cognitive and social factors that affect the patients response. In this article, we will review the documentation and billing requirements necessary for getting paid. 96161 is to be reported to the patient's health plan as it is a service for the benefit of the patient. There are no diagnosis code limitations being applied at this time. Code 96146, 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). 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. 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 comments are moderated and will be removed if they violate ourTerms of Use. This is often included in the test itself, but these elements may alternatively be documented in the progress report of the visit. required field. 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. 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. It begins with a listing of transition-related CPT codes and corresponding Medicare fees and relative value units (RVUs), effective as of 2022. . Clinical staff administer and score a structured screening instrument for depression with positive results. 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement 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. The healthcare provider discusses the results with the patient and provides recommendations for managing or reducing identified health risks. 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 of the Medicare program. Are HRAs Bundled Into E/Ms or Other Services? The patient completes the questionnaire, providing information about their health and lifestyle. HCPCS modifiers such as modifier EP may be required by Medicaid plans to indicate a service was provided as part of a Medicaid early periodic screening diagnosis and treatment program, or they may require other state-defined modifiers. CPT is a registered trademark of the American Medical Association.". recipient email address(es) you enter. 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. 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. This is often included in the test itself, but these elements may alternatively be documented in the progress report of the visit itself. In most instances Revenue Codes are purely advisory. A patient with a history of alcohol abuse completes a liver disease risk assessment instrument. Are HRAs Bundled Into E/Ms or Other Services? 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. Applicable FARS/HHSARS apply. If your session expires, you will lose all items in your basket and any active searches. The code lists in the article help explain which services (procedures) the related LCD applies to, the diagnosis codes for which the service is covered, or for which the service is not considered reasonable and necessary and therefore not covered. The CMS.gov Web site currently does not fully support browsers with See the CMS . AHA copyrighted materials including the UB‐04 codes and A neuropsychologist is completing a neuropsychological evaluation. Please try reloading page. Before sharing sensitive information, make sure you're on a federal government site. Review the article, in particular the Coding Information section. 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. To submit a comment or question to CMS, please use the Feedback/Ask a Question link available at the bottom Instructions for enabling "JavaScript" can be found here. . When reporting multiple units of the same or different screening instruments, modifier 59, XE, XP, XS, or XU may be required to indicate distinct services. CPT code 96160 allows allergists to get reimbursed when they make use of certain standardized asthma assessment instruments. Codes 96110, 96160, and 96161 are typically limited to developmental screening and the health risk assessment (HRA). CPT 96150: This code is used for an initial health and behavior assessment conducted by a healthcare professional. Because health risk assessments (HRAs) appear so similar to other assessment services, using the HRA codes can be a real gamble. 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. The effective date of this revision is based on date of service. Related policy n/a References Center for Disease Control and Prevention (CDC). The Medicare program provides limited benefits for outpatient prescription drugs. If you need an accommodation or require documents in another format, please call 1-800-562- 3022. Quality initiatives may include incentives for performing and reporting recommended screenings and assessments, which provides an additional reason to familiarize yourself with these codes. 7500 Security Boulevard, Baltimore, MD 21244. used to report this service. Although the fee-for-service payment for screening and assessments may be small, it can add up to significant income across a patient panel. This page displays your requested Article. 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. 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. This year CPT has added code 99211 to the list and included patient- and caregiver-focused health risk assessment codes 96160 and 96161. "JavaScript" disabled. All Rights Reserved. When using Edinburgh Postnatal Depression Screening to screen for depression in pregnant or postpartum patients, it is more appropriate to report CPT code 96160, Administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument. The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. Separate billing for scoring and report preparation is not allowed. 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. The following CPT codes are not applicable for developmental delay screening or testing: 96160, 96161, 99411, 99412, 99429. that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes. 96160 Administration of patient-focused health risk assessment instrument (e.g., . 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. Any follow-up appointments or referrals made based on the assessment results. A Draft article will eventually be replaced by a Billing and Coding article once the Proposed LCD is released to a final LCD. For example, Aetna clearly encourages and pays for depression screening reported with code 96127 and ICD-10 code Z13.89, Encounter for screening for other disorder. Cigna has a national policy that provides separate coverage of developmental screening (96110), brief behavioral health assessment (96127), and depression screening reported with HCPCS code G0444. Washington Apple Health means the public health insurance programs for eligible Washington residents. The CPT Codes discussed in this Billing and Coding Article are used to report the services provided during testing of the cognitive function of the central nervous system. The HRA codes are subject to PTP edits when reported with the other screening and assessment codes, however. Article revised and published on 9/9/2021 effective for dates of service on and after 01/01/2020 in response to an inquiry for clarification to the article. article does not apply to that Bill Type. This email will be sent from you to the The American Hospital Association ("the AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. It is conducted through health focused interviews, observations, and clinical decision making. Reproduced with permission. When reporting CPT codes 96159, 96165, and 96168, the quantity billed should reflect 1 unit for each 15 minutes. A patient with a history of exposure to hazardous chemicals completes an occupational health risk assessment instrument. that coverage is not influenced by Bill Type and the article should be assumed to LCD revised to add CPT/HCPCS codes 96160, 96161, and G0505. Medicaid and the State Children's Health Insurance Programs, contracts with certain organizations to assist in the administration For this supplementary claims processing information we rely on other CMS publications, namely Change Requests (CR) Transmittals and inclusions in the Medicare Fee-For-Service Claims Processing Manual (CPM). 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. 96127 Brief emotional/behavioral assessment (e.g., depression inventory, attention-deficit/hyperactivity disorder scale), with scoring and documentation, per standardized instrument Guidance on when to use this code for Pediatric well visits: Add this code when complete Adolescent Depression screening Tool (11+ years) Report ICD-10 code Z13.89, Encounter for screening for other disorder, in conjunction with depression screening services. damages arising out of the use of such information, product, or process. 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. 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. Unless specified in the article, services reported under other But you can quickly learn to use screening and assessment codes effectively and accurately. Health and behavioral intervention is the promotion of functional improvements in the patients psychological and psychosocial condition. As used herein, "you" and "your" refer to you and any organization on behalf of which you are acting. For more information, please visit ACOGs Solutions section (May 2015, Perinatal Depression). presented in the material do not necessarily represent the views of the AHA. An asterisk (*) indicates a 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. To report, see 96127, 96136, 96137, 96138, 96139. Try using the MCD Search to find what you're looking for. 4) Visit Medicare.gov or call 1-800-Medicare. The patient expresses a feeling of hopelessness related to relationships lost during opioid use and sexuality issues. 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. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available. CPT codes, descriptions and other data only are copyright 2022 American Medical Association. 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. 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. Getting Paid for Screening and Assessment Services. All documentation must be maintained in the patient's medical record and made available to the contractor upon request. Example: An 18-month-old established patient is seen for a well-child exam. However, please note that once a group is collapsed, the browser Find function will not find codes in that group. The results are documented in the medical record. 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. an effective method to share Articles that Medicare contractors develop. If you dont find the Article you are looking for, contact your MAC. 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. apply equally to all claims. Sign up to receive FPM's free, weekly e-newsletter, "Quick Tips & Insights," featuring practical, peer-reviewed advice for improving practice, enhancing the patient experience, and developing a rewarding career. Local Coverage Articles are a type of educational document published by the Medicare Administrative Contractors (MACs). CRs are not policy, rather CRs are used to relay instructions regarding the edits of the various claims processing systems in very descriptive, technical language usually employing the codes or code combinations likely to be encountered with claims subject to the policy in question. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not So, 96110 and 96127 are used whenever your provider is assessing a patients psychological and neuropsychological condition, such as a patients memory, language, visual motor responses, and abstract reasoning/ problem-solving abilities, whereas 96160/96161 are used whenever your provider is assessing how a psychological condition is impacting a patients health condition (96160) or how the patients caregivers psychological condition may affect the caregivers ability to care for the patient (96161). http://www.cdc.gov/ncbddd/childdevelopment/screening.html Heres your guide to risk-free screening and assessment coding. Remaining CPT codes will be required facetoface (more information on later slides). 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.
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