documentation requirements for cpt code 96160

PDF Coding & Billing Guide December 2018 Updates - NCDHHS 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 results are documented in the medical record. How Do 96160/96161 Differ From Each Other? Humana Practitioner Assessment Form (PAF) 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. When 96160 is billed with CPT code 96127: modifier 59 must be added to the EP modifier To indicate Referrals use Z00.121 (pg. | Terms and Conditions of Use. 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. 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. G0439 - Subsequent visit. Do not reportCPT codes 96156, 96158, 96159, 96164, 96165, 96167 and 96168 in addition to codes for psychiatry services on the same date. Review the article, in particular the Coding Information section. A healthcare provider administers a nutrition risk assessment questionnaire to a patient with a history of poor dietary habits. See permissionsforcopyrightquestions and/or permission requests. 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. For more information, please visit ACOGs Solutions section (May 2015, Perinatal Depression). "JavaScript" disabled. (You may have to accept the AMA License Agreement.) It is conducted through health focused interviews, observations, and clinical decision making. However, if the physician diagnoses depression, you may report it separately since the global package was valued for uncomplicated antepartum, delivery, and postpartum care. Some payers require reporting 96127 for HEEADSSS and CRAFFT screenings. not endorsed by the AHA or any of its affiliates. Applicable FARS/HHSARS apply. The views and/or positions Applications are available at the American Dental Association web site. 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. Look for a Billing and Coding Article in the results and open it. CPT codes, descriptions and other data only are copyright 2022 American Medical Association. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Sign up to get the latest information about your choice of CMS topics in your inbox. 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. 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). The guidelines of the Correct Coding Initiative (CCI) supersede all coding instructions in this Billing and Coding Article. Please try reloading page. HCPCS/CPT Codes. Changes to CPT codes for structured screenings and brief assessments have led some payers to expand coverage for these services. 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. Heres your chance to prove you know your way around the F01-F99 codes. (e.g., transition readiness assessment) with scoring and documentation, per standardized instrument $2.77 NA 0.08 . These patients may have a family history of certain diseases, exhibit risk factors such as obesity or smoking, or have a history of exposure to environmental hazards. This email will be sent from you to the Codes 96110, 96160, and 96161 are typically limited to developmental screening and the health risk assessment (HRA). ). While every effort has been made to provide accurate and Any questions pertaining to the license or use of the CPT should be addressed to the AMA. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CPT codes 96150, 96151, 96152, 96153, 96154, and 96155 were deleted. LCD - Health and Behavior Assessment/Intervention (L33834) For more information, visit Getting Paid for Screening and Assessment Services at www.aafp.org/fpm/2017/1100/fpm20171100p25.pdf and A Framework for Patient-Centered Health Risk Assessments at www.cdc.gov/policy/hst/HRA/FrameworkForHRA.pdf. As used herein, "you" and "your" refer to you and any organization on behalf of which you are acting. Code96146, 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). All you have to do is learn the answers to these frequently asked questions. Using Alcohol Screening and Brief Intervention to Address Patients used to report this service. 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. 96160 96161 CPT 96160, Under Health Behavior Assessment and Intervention Procedures The Current Procedural Terminology (CPT ) code 96160 as maintained by American Medical Association, is a medical procedural code under the range - Health Behavior Assessment and Intervention Procedures. 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). Report CPT code 90791 for the psychiatric diagnostic interview and G0396 indicating the performance of 15-30 minutes of SBIRT services. 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. Use for both screening and follow-up of emotional and behavioral health conditions. Refer to the current HCPG for examples of other scientifically validated screening tools for adolescent health risk. 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. Getting Paid for Screening and Assessment Services | AAFP Another option is to use the Download button at the top right of the document view pages (for certain document types). Federal government websites often end in .gov or .mil. This content is owned by the AAFP. CMS and its products and services are However, only 96160/96161 involve administering, scoring, and documenting a standardized instrument. Four screening codes you should be using | AAFP 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). CPT code 96150 : Health and behavior initial assessment, each 15 minutes face-to-face with the patient CPT code 96151 : Health and behavior re-assessment, each 15 minutes face-to-face with the patient Deleted H&B Assessment Services (Effective 1/1/2020) 6 Instrument-based assessment of the patient's risk for certain health conditions, behaviors that may negatively impact health, and pros and cons for initiating behavior change, Mini Nutritional Assessment - Short Form, Acute Concussion Evaluation, Alcohol Use Disorders Identification Test, CRAFFT (Care, Relax, Alone, Forget, Friends, Trouble), and HEE-ADSSS (Home, Education, Eating, Activities, Drugs and Alcohol, Suicide and Depression, Sexuality and Safety). A Draft article will eventually be replaced by a Billing and Coding article once the Proposed LCD is released to a final LCD. Try using the MCD Search to find what you're looking for. A patient with a family history of osteoporosis completes a bone health risk assessment instrument. End User License Agreement: If you are looking for a specific code, use your browser's Find function (Ctrl-F) to quickly locate the code in the article. This is often included in the test itself, but these elements may alternatively be documented in the progress report of the visit. How Do 96160/96161 Differ From Each 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. All comments are moderated and will be removed if they violate ourTerms of Use. Instructions for enabling "JavaScript" can be found here. Heres your guide to risk-free screening and assessment coding. PDF Introduction to the 2020 Health Behavior Assessment and Intervention 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. The instrument is scorable. 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. The AMA does not directly or indirectly practice medicine or dispense medical services. (96160/96161) Codes 99408/99409 cannot be reported for the same patient, on the same date of service, as Health Behavior Assessment . If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. recipient email address(es) you enter. Compliance with the provisions in LCD L33834, Health and Behavior Assessment/Intervention may be monitored and addressed through post payment data analysis and subsequent medical review audits. 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. CPT is a registered trademark of the American Medical Association.". CPT codes, descriptions and other data only are copyright 2022 American Medical Association. 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. Quality initiatives may include incentives for performing and reporting recommended screenings and assessments, which provides an additional reason to familiarize yourself with these codes. A healthcare provider administers a cardiovascular risk assessment questionnaire to a patient with a family history of heart disease. Codes 96160-96161 are reported in addition to the evaluation and management (E/M) code (eg, 99213). This test is performed using an electronic platform, such as a computer, and the results of the test are automatically generated. The list of results will include documents which contain the code you entered. The following CPT codes are not applicable for developmental delay screening or testing: 96160, 96161, 99411, 99412, 99429. 25 Coding Question: Postpartum Depression Screening | ACOG Because health risk assessments (HRAs) appear so similar to other assessment services, using the HRA codes can be a real gamble. The specific standardized health risk assessment instrument used. 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. If a redetermination is requested, documentation showing the 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. 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. Health and behavioral assessment is an evaluation of psychological, behavioral, emotional, cognitive and social factors that affect the patients response. All Rights Reserved. Although an HRA is bundled in the AWV under Medicare Part B, code 96160 may be billed separately in Medicare Advantage plan quality initiatives. CPT Code 96160 - Health Behavior Assessment and Intervention 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. You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. This year CPT has added code 99211 to the list and included patient- and caregiver-focused health risk assessment codes 96160 and 96161. Because health risk assessments (HRAs) appear so similar to other assessment services, using the HRA codes can be a real gamble. Heres your guide to risk-free screening and assessment coding. 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. required field. DOCUMENTATION GUIDELINES 96110 Each administered developmental screening instrument is accompanied by scoring and documentation (eg, a score or designation as normal or abnormal). These materials contain Current Dental Terminology (CDTTM), copyright© 2022 American Dental Association (ADA). The contractor information can be found at the top of the document in the Contractor Information section (expand the section to see the details). Draft articles have document IDs that begin with "DA" (e.g., DA12345). This code may also be reported for depression screening in adult patients other than Medicare beneficiaries. Medicaid reimburses providers for CPT code 96160 to a maximum of two units per visit. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. 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. Evidence of a referral to the Clinical Psychologist by the medical provider responsible for the medical management of the patients physical illness or verification of a recommendation from the medical provider to the Clinical Psychologist, obtained by request and review of the permanent medical record, must be documented in the medical record for the initial assessment and for reassessment. The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. CPT Code 96160 may not be used to claim a stand-alone administration of a CRAFFT (CPT Code 96127) brief screen. 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. 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. Medicaid and the State Children's Health Insurance Programs, contracts with certain organizations to assist in the administration The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. These services are encouraged by active involvement of the patient/family. In this article, we will review the documentation and billing requirements necessary for getting paid. 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. ICD-10 CM diagnosis code(s) reflecting the physical condition(s) being treated must be present on the claim as the primary diagnosis. 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. Complete absence of all Revenue Codes indicates CPT 96160 was added to the Current Procedural Terminology system on January 1, 2017. Health Risk Assessment Codes and How to Use Them Billing and Coding: Psychological and Neuropsychological Testing A healthcare provider administers a skin cancer risk assessment questionnaire to a patient with a history of sunburns and tanning bed use. All Rights Reserved (or such other date of publication of CPT). 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: 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 (, Find Out Whats Going to Be in Your Practices Wallet This Year, Office and telephone E/M increases significantly offset preventive service decreases. 2) Try using the MCD Search and enter your information in the "Enter keyword, code, or document ID" box. However, code 96127 should be reported for both screening and follow-up of emotional and behavioral health conditions. copied without the express written consent of the AHA. Article - Billing and Coding: Health and Behavior Assessment/Intervention (A57754). Please review and accept the agreements in order to view Medicare Coverage documents, which may include licensed information and codes. All rights reserved. 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. 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. If you need more information on coverage, contact the Medicare Administrative Contractor (MAC) who published the document. Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. ICD-10 Codes. The program covers drugs that are furnished "incident-to" a physician's service provided that the drugs are not "usually self-administered" by the patient. If you do not agree with all terms and conditions set forth herein, click below on the button labeled "I do not accept" and exit from this computer screen. A patient with a history of alcohol abuse completes a liver disease risk assessment instrument. In most instances Revenue Codes are purely advisory. Any follow-up appointments or referrals made based on the assessment results. Child Development/Developmental Monitoring and Screening. The provider documents the assessment instrument used, the patients score, and any related discussions or recommendations in the patients medical record. The physician reports code 99392 for the preventive service and two units of code 96110 for the administration of the structured screening instruments. If you are experiencing any technical issues related to the search, selecting the 'OK' button to reset the search data should resolve your issues. 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. There are multiple ways to create a PDF of a document that you are currently viewing. Codes 96110, 96160, and 96161 are typically limited to developmental screening and the health risk assessment (HRA). http://www.cdc.gov/ncbddd/childdevelopment/screening.html For 2019, a new code (96146) has been developed to describe an automated psychological or neuropsychological test that includes generation of an automated result. 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. MACs can be found in the MAC Contacts Report. These codes do not represent physician work. For payment purposes, each screening and assessment code was valued based on practice expense and professional liability only, which includes the cost of furnishing instruments (when applicable) and staff time to administer and/or score an instrument for the physician or other qualified health care professional's review.
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