documentation requirements for cpt code 96160

PDF Developmental Screening/Testing Coding Fact Sheet for Primary - CDC Use for both screening and follow-up of emotional and behavioral health conditions. Some payers require reporting 96127 for HEEADSSS and CRAFFT screenings. if(typeof ez_ad_units != 'undefined'){ez_ad_units.push([[320,100],'codingahead_com-box-3','ezslot_1',147,'0','0'])};__ez_fad_position('div-gpt-ad-codingahead_com-box-3-0');CPT 96160 is a medical billing code used to represent the administration of a patient-focused health risk assessment instrument, such as a health hazard appraisal, with scoring and documentation. 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. 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. 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. The HRA codes are subject to PTP edits when reported with the other screening and assessment codes, however. The contractor information can be found at the top of the document in the Contractor Information section (expand the section to see the details). Billing and Coding articles provide guidance for the related Local Coverage Determination (LCD) and assist providers in submitting correct claims for payment. LCD - Health and Behavior Assessment/Intervention (L33834) Quick reference: Screening and assessment codes, Screening Your Adult Patients for Depression, Childhood instrument-based screening for failure to develop and/or achieve skills according to the expected time frame (e.g., expressive and receptive language, motor skills), Ages & Stages Questionnaires Third Edition, Parents' Evaluation of Developmental Status, and Modified Checklist for Autism in Toddlers Revised With Follow-Up. This content is owned by the AAFP. In accordance with CMS Ruling 95-1 (V), utilization of these services should be consistent with locally acceptable standards of practice. Although an HRA is bundled in the AWV under Medicare Part B, code 96160 may be billed separately in Medicare Advantage plan quality initiatives. What Counts as a Standardized Instrument? 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. Applicable Federal Acquisition Regulation Clauses (FARS)/Department of Defense Federal Acquisition Regulation supplement (DFARS) Restrictions Apply to Government Use. If your session expires, you will lose all items in your basket and any active searches. CPT 96127: This code is used for the administration of a brief emotional/behavioral assessment with scoring and documentation. (Monday through Friday, 8:30 a.m. to 5 p.m. CPT is a registered trademark of the American Medical Association.". 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. The AMA is a third party beneficiary to this Agreement. 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. 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. 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. A healthcare provider administers a cardiovascular risk assessment questionnaire to a patient with a family history of heart disease. 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. The submitted medical record must support the use of the selected ICD-10-CM code(s). CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. Please contact the Medicare Administrative Contractor (MAC) who owns the document. of the Medicare program. CPT 96150: This code is used for an initial health and behavior assessment conducted by a healthcare professional. 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. Refer to the current HCPG for examples of other scientifically validated screening tools for adolescent health risk. CPT 96138: This code is used for the administration and scoring of psychological or neuropsychological tests by a technician. CPT codes, descriptions and other data only are copyright 2022 American Medical Association. CPT 96160 was added to the Current Procedural Terminology system on January 1, 2017. The document is broken into multiple sections. MLN6775421 - Medicare Wellness Visits - Centers for Medicare CPT codes 96158, 96164, and 96167 should not be reported for less than 16 minutes of service. Author disclosure: no relevant financial affiliations disclosed. For example, Texas Health Steps pays for adolescent mental health screening using specified structured instruments reported with code 96160 when completed by the patient, and 96161 when completed by a caregiver. Complete absence of all Revenue Codes indicates 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. All Rights Reserved. Heres your guide to risk-free screening and assessment coding. 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. The physician reports code 99392 for the preventive service and two units of code 96110 for the administration of the structured screening instruments. This blog is not intended to provide medical, financial, or legal advice. Although an HRA is bundled in the AWV under Medicare Part B, code 96160 may be billed separately in Medicare Advantage plan quality initiatives. MACs can be found in the MAC Contacts Report. 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. Key CPT and Medicare Changes for Family Medicine in 2022 When billing for non-covered services, use the appropriate modifier. The views and/or positions presented in the material do not necessarily represent the views of the AHA. Quality initiatives may include incentives for performing and reporting recommended screenings and assessments, which provides an additional reason to familiarize yourself with these codes. 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. In this article, we will review the documentation and billing requirements necessary for getting paid. 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). However, some payers may reimburse for this service. Coding for Developmental & Mental Health Screening 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. 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. 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. These materials contain Current Dental Terminology (CDTTM), copyright© 2022 American Dental Association (ADA). Billing and Coding articles typically include CPT/HCPCS procedure codes, ICD-10-CM diagnosis codes, as well as Bill Type, Revenue, and CPT/HCPCS Modifier codes. Be aware that some payers will only reimburse psychologists and psychiatrists for treating depression. ICD-10 codes for routine health examinations (Z00.0-, Z00.1-) should be reported in conjunction with recommended HRAs performed at the same encounter. ICD-10 CM diagnosis code(s) reflecting the physical condition(s) being treated must be present on the claim as the primary diagnosis. To report, see 96127, 96136, 96137, 96138, 96139. If you're not coding and billing for these services, you might be leaving money on the table. A healthcare provider administers a diabetes risk assessment questionnaire to a patient with obesity and a sedentary lifestyle. 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). Getting Paid for Screening and Assessment Services | AAFP LCD revised to add CPT/HCPCS codes 96160, 96161, and G0505. Coding Question: Postpartum Depression Screening | ACOG How Do 96160/96161 Differ From Each Other? Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service [s]). 2) Try using the MCD Search and enter your information in the "Enter keyword, code, or document ID" box. This email will be sent from you to the Before sharing sensitive information, make sure you're on a federal government site. People who have hearing or speech disabilities, please call 711 for relay services. Are HRAs Bundled Into E/Ms or Other Services? Please enable "JavaScript" and revisit this page or proceed with browsing CMS.gov with 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) 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 rights reserved. If a redetermination is requested, documentation showing the CPT 96146: This code is used for the administration of a computerized adaptive psychological or neuropsychological test with a qualified health professionals interpretation and report. The CMS.gov Web site currently does not fully support browsers with Please try reloading page. Heres your chance to prove you know your way around the F01-F99 codes. You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement. 21) Some articles contain a large number of codes. 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. 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.

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