Sign up to get the latest information about your choice of CMS topics in your inbox. Draft articles have document IDs that begin with "DA" (e.g., DA12345). Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). That portion of the visit must be medically necessary and reasonable to treat the patient's illness or injury or to improve the functioning of a malformed body part. Please do not use this feature to contact CMS. Procedure Coding: Get the Answers to Your Frequently Asked HRA Questions, Get the Answers to Your Frequently Asked HRA Questions, Simply put, the two differ over who is being assessed. 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. The healthcare provider reviews the patients responses and analyzes the results. If test is administered by physician, other qualified health care professional, or technician, do not report 96146. In this article, we will review the documentation and billing requirements necessary for getting paid. A summary of the discussion between the provider and patient regarding the results and any recommendations for managing or reducing identified health risks. Applicable FARS\DFARS Restrictions Apply to Government Use. If you need an accommodation or require documents in another format, please call 1-800-562- 3022. Complete absence of all Revenue Codes indicates The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Cognitive Assessment and Care Plan Service L39266. CPT codes, descriptions and other data only are copyright 2022 American Medical Association. Additional Coding Considerations for Well Visits: 96110, 96127, 96160 The physician reports code 99392 for the preventive service and two units of code 96110 for the administration of the structured screening instruments. 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. For all claims, time duration (stated in minutes) spent in the health and behavioral assessment or intervention encounter should be documented in the medical record. Applicable Federal Acquisition Regulation Clauses (FARS)/Department of Defense Federal Acquisition Regulation supplement (DFARS) Restrictions Apply to Government Use. Please review and accept the agreements in order to view Medicare Coverage documents, which may include licensed information and codes. Payer guidance for reporting postpartum depression screening also varies. You must know your specific payer policies. 21) Specifically, CPT code 96160 describes the administration of patient-focused health risk assessment instruments with scoring and documentation, per standardized instrument. 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. Further Clarifications on the Use of 96160 and 96161 damages arising out of the use of such information, product, or process. "JavaScript" disabled. However, only 96160/96161 involve administering, scoring, and documenting a standardized instrument. An official website of the United States government. For HPQ-9 depression screening, some payers accept evaluation and management code with modifier 25 billed with 96161/96160, while others request CPT code 96127, Brief emotional/behavioral assessment (eg, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Report ICD-10 code Z13.89, Encounter for screening for other disorder, in conjunction with depression screening services. 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. In addition, most are recommended preventive services, and some may also be factored into performance ratings and quality initiatives. Procedure Codes for Screening and Assessment Services Flexibility #6 17 18 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. If the physician is providing the global obstetrical service (and reporting a global code), the payer may consider screening depression as part of the global service and not reimburse additionally for the service. 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. 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.. Some payers require reporting 96127 for HEEADSSS and CRAFFT screenings. Alcohol and Substance Abuse Screening and Brief Intervention (i.e., CRAFFT) pg. The patient completes the questionnaire, providing information about their health and lifestyle. A patient with a history of exposure to hazardous chemicals completes an occupational health risk assessment instrument. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). Who Is Covered. Quality initiatives may include incentives for performing and reporting recommended screenings and assessments, which provides an additional reason to familiarize yourself with these codes. and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only The list of results will include documents which contain the code you entered. The document is broken into multiple sections. For instance, one plan in Tennessee has paid. 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. For 2019, a new code (96146) has been developed to describe an automated psychological or neuropsychological test that includes generation of an automated result. For the intervention service, progress notes must include, at a minimum, the following elements: Evidence that the patient has the capacity to understand and to respond meaningfully, and, Clearly defined psychological intervention planned, and, The goals of the psychological intervention should be stated clearly, There should be documentation that the psychological intervention is expected to improve compliance with the medical treatment plan, and, Rationale for frequency and duration of services. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service [s]). 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. Refer to the LCD for reasonable and necessary requirements and limitations. Save my name, email, and website in this browser for the next time I comment. accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the 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. 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. 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. Contractors may specify Bill Types to help providers identify those Bill Types typically PDF Developmental Delay Screening and Testing Guidelines - Blue Cross NC (For more information, see Screening Your Adult Patients for Depression, FPM, March/April 2016.) You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. (You may have to accept the AMA License Agreement.) The following CPT codes are not applicable for developmental delay screening or testing: 96160, 96161, 99411, 99412, 99429. 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. American Hospital Association ("AHA"), https://www.cdc.gov/policy/hst/HRA/FrameworkForHRA.pdf. Author disclosure: no relevant financial affiliations disclosed. Unless specified in the article, services reported under other 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. The effective date of this revision is based on date of service. G0438 - Initial visit. To support a claim for CPT 96160, the following information should be documented in the patients medical record: When billing for CPT code 96160, it is important to remember that the code includes the administration of the standardized questionnaire, scoring, and documentation. The contractor information can be found at the top of the document in the Contractor Information section (expand the section to see the details). A healthcare provider administers a nutrition risk assessment questionnaire to a patient with a history of poor dietary habits. 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). The submitted medical record must support the use of the selected ICD-10-CM code(s). | Terms and Conditions of Use. CPT codes 96150 - 96154 are to be billed as one service for each 15 minute of face-to-face contact with the beneficiary(s). 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. (See last page for instructions. 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. 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. You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement. Are HRAs Bundled Into E/Ms or Other Services? Health and behavioral intervention is the promotion of functional improvements in the patients psychological and psychosocial condition. 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. MLN6775421 - Medicare Wellness Visits - Centers for Medicare 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. 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. ICD-10 Codes. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be CMS believes that the Internet is However, if the physician diagnoses depression, you may report it separately since the global package was valued for uncomplicated antepartum, delivery, and postpartum care. Another option is to use the Download button at the top right of the document view pages (for certain document types). Copyright 2023 American Academy of Family Physicians. Example: An 18-month-old established patient is seen for a well-child exam. 6. Please contact the Medicare Administrative Contractor (MAC) who owns the document. A patient with a family history of Alzheimers disease completes a cognitive decline risk assessment instrument. 27) Encounter for routine child health exam with abnormal findings Depression Screening (pg. Copyright 2023 American Academy of Family Physicians. CPT Code 96160 may not be used to claim a stand-alone administration of a CRAFFT (CPT Code 96127) brief screen. Many Medic-aid plans have adopted code 96161 for screening for postpartum depression at well-baby visits (some may allow up to six screenings before the child is 13 months old). All documentation must be maintained in the patient's medical record and made available to the contractor upon request. The contractor information can be found at the top of the document in the, Please use the Reset Search Data function, found in the top menu under the Settings (gear) icon. 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. The AMA is a third party beneficiary to this Agreement. This is often included in the test itself, but these elements may alternatively be documented in the progress report of the visit. 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. This is particularly true if the physician routinely screens every patient for depression. To submit a comment or question to CMS, please use the Feedback/Ask a Question link available at the bottom The scope of this license is determined by the AMA, the copyright holder. Billing 96161 on Well Baby | Medical Billing and Coding Forum - AAPC 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).