documentation requirements for cpt code 96160

Self-Administered Drug (SAD) Exclusion List articles list the CPT/HCPCS codes that are excluded from coverage under this category. When billing for non-covered services, use the appropriate modifier. . However, code 96127 should be reported for both screening and follow-up of. Copyright © 2022, the American Hospital Association, Chicago, Illinois. Copyright 2023 American Academy of Family Physicians. Documentation Requirements. 96161 is to be reported to the patient's health plan as it is a service for the benefit of the patient. Response to Comment (RTC) articles list issues raised by external stakeholders during the Proposed LCD comment period. 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). Additional Coding Considerations for Well Visits: 96110, 96127, 96160 A patient with a family history of Alzheimers disease completes a cognitive decline risk assessment instrument. Instrument-based assessment of the caregiver's risk for certain health conditions that may impact his or her ability to care for the patient, Safe Environment for Every Kid, Caregiver Strain Index, and Edinburgh Postnatal Depression Scale (administered for benefit of the child). If you are not billing for these services, you may be losing out on valuable revenue. Coding for Developmental & Mental Health Screening In addition, most are recommended preventive services, and some may also be factored into performance ratings and quality initiatives. Getting Paid for Screening and Assessment Services | AAFP Additionally, if a similar instrument is administered to a patients caregiver, such as for assessing the patients risk of developing depression, CPT code 96161 should be used instead. CPT is a trademark of the American Medical Association (AMA). Remaining CPT codes will be required facetoface (more information on later slides). CDT is a trademark of the ADA. It is conducted through health focused interviews, observations, and clinical decision making. The following CPT codes are not applicable for developmental delay screening or testing: 96160, 96161, 99411, 99412, 99429. The physician reports code 99392 for the preventive service and two units of code 96110 for the administration of the structured screening instruments. Flexibility #6 17 18 Payment policies and claims edits are constantly changing and should be systematically monitored. The submitted medical record must support the use of the selected ICD-10-CM code(s). 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. Your MCD session is currently set to expire in 5 minutes due to inactivity. 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. recipient email address(es) you enter. CMS believes that the Internet is Instructions for enabling "JavaScript" can be found here. CPT 96160 was added to the Current Procedural Terminology system on January 1, 2017. All rights reserved. Codes 96110, 96160, and 96161 are typically limited to developmental screening and the health risk assessment (HRA). (See last page for instructions. CPT 96160 is a code used for the administration of patient-focused health risk assessment instruments, including scoring and documentation. 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. authorized with an express license from the American Hospital Association. 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. A healthcare provider administers a nutrition risk assessment questionnaire to a patient with a history of poor dietary habits. "JavaScript" disabled. Documentation 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/scoring the instrument. It is worth the effort to determine which payers in your area pay for these services. 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. Any follow-up appointments or referrals made based on the assessment results. The contractor information can be found at the top of the document in the Contractor Information section (expand the section to see the details). How to bill for brief substance and alcohol abuse services Example: An 18-month-old established patient is seen for a well-child exam. Enter the code you're looking for in the "Enter keyword, code, or document ID" box. The 96160 CPT code procedure involves the following steps: Patients eligible to receive CPT code 96160 services are those who may be at risk for developing specific health issues or conditions. Please contact your Medicare Administrative Contractor (MAC). CPT Code 96160 - Health Behavior Assessment and Intervention 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. Applicable FARS\DFARS Restrictions Apply to Government Use. 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. Medicaid and the State Children's Health Insurance Programs, contracts with certain organizations to assist in the administration PDF Coding & Billing Guide December 2018 Updates - NCDHHS 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. Although an HRA is bundled in the AWV under Medicare Part B, code 96160 may be billed separately in Medicare Advantage plan quality initiatives. The CPT codes 96156, 96158, 96159, 96164, 96165, 96167 and 96168 may be used only by a Clinical Psychologist (CP), (Specialty Code 68). Do not reportCPT codes 96156, 96158, 96159, 96164, 96165, 96167 and 96168 in addition to codes for psychiatry services on the same date. For the most part, codes are no longer included in the LCD (policy). See the CMS . 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). By clicking below on the button labeled "I accept", you hereby acknowledge that you have read, understood and agreed to all terms and conditions set forth in this agreement. Because health risk assessments (HRAs) appear so similar to other assessment services, using the HRA codes can be a real gamble. Complete absence of all Revenue Codes indicates 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. Code 96127 is also applicable to assessments for conditions such as anxiety, attention-deficit disorders, and generalized psychosocial symptoms (e.g., pediatric symptom checklist). 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 purpose of the screening or assessment should guide code selection. These codes do not represent physician work. Code 96161, on the other hand, assesses a caregiver for the patient, not the patient him/herself, when the caregiver may have a condition that is affecting the patient. If you would like to extend your session, you may select the Continue Button. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available. Staff administer and score two structured screening instruments for development and autism. 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. Four screening codes you should be using | AAFP The AMA is a third party beneficiary to this Agreement. All Rights Reserved. descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work 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 codes 96150, 96151, 96152, 96153, 96154, and 96155 were deleted. What Counts as a Standardized Instrument? 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.
Crunchy Food Psychology, Articles D