documentation requirements for cpt code 96160

There are no diagnosis code limitations being applied at this time. The AMA does not directly or indirectly practice medicine or dispense medical services. All Rights Reserved. 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. For assessments of specific risks such as caregiver strain, report code Z13.89. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. (See last page for instructions. A patient with a history of smoking completes a lung cancer risk assessment instrument under the guidance of their healthcare provider. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled "I Accept". If your session expires, you will lose all items in your basket and any active searches. 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. Although the fee-for-service payment for screening and assessments may be small, it can add up to significant income across a patient panel. 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 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. A patient with a family history of osteoporosis completes a bone health risk assessment instrument. 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 healthcare provider reviews the patients responses and analyzes the results. The page could not be loaded. End User License Agreement: CPT 96150: This code is used for an initial health and behavior assessment conducted by a healthcare professional. The effective date of this revision is based on date of service. Some payers require reporting 96127 for HEEADSSS and CRAFFT screenings. A patient with a family history of Alzheimers disease completes a cognitive decline risk assessment instrument. It begins with a listing of transition-related CPT codes and corresponding Medicare fees and relative value units (RVUs), effective as of 2022. . 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. Who Is Covered. recommending their use. Any follow-up appointments or referrals made based on the assessment results. 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) The physician recommends a consultation with a psychologist for management of moderate major depression, and a staff member arranges the appointment for later in the week. The healthcare provider selects an appropriate standardized health risk assessment instrument for the patient. 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. Sign up to get the latest information about your choice of CMS topics in your inbox. However, only 96160/96161 involve administering, scoring, and documenting a standardized instrument. ). In accordance with CMS Ruling 95-1 (V), utilization of these services should be consistent with locally acceptable standards of practice. CPT codes 96150 - 96154 are to be billed as one service for each 15 minute of face-to-face contact with the beneficiary(s). Look for a Billing and Coding Article in the results and open it. 2) Try using the MCD Search and enter your information in the "Enter keyword, code, or document ID" box. 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. The provider documents the assessment instrument used, the patients score, and any related discussions or recommendations in the patients medical record. 96161 should be reported for use of a standardized instrument to screen for health risks in the caregiver for the benefit of the patient. Additional Coding Considerations for Well Visits: 96110, 96127, 96160 Revision Number: 1 Publication: December 2019 Connection LCR B2020-001. Changes to CPT codes for structured screenings and brief assessments have led some payers to expand coverage for these services. Save my name, email, and website in this browser for the next time I comment. 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). 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. Because the depression screening does not require an interpretation and report, it is not separately paid by this payer. 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). Because health risk assessments (HRAs) appear so similar to other assessment services, using the HRA codes can be a real gamble. Copyright 2023 American Academy of Family Physicians. This is particularly true if the physician routinely screens every patient for depression. Codes 96110, 96160, and 96161 are typically limited to developmental screening and the health risk assessment (HRA). 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. To report, see 96127, 96136, 96137, 96138, 96139. and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only 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. 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. Disclaimer: The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. PDF Behavioral Health Telehealth Update article does not apply to that Bill Type. 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. 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. Example A: An adult established patient with opioid addiction, currently in remission, is seen for a routine physical examination. This is based on CPT guidance for central nervous system assessments that states, It is expected that the administration of these tests will generate material that will be formulated into a report. Verify your payers' documentation requirements prior to providing these services. If you would like to extend your session, you may select the Continue Button. G0438 - Initial visit. CPT 96160 was added to the Current Procedural Terminology system on January 1, 2017. All rights reserved. If a redetermination is requested, documentation showing the Example B: Imagine the same scenario as in example A, but the patient has a different health plan. Diagnosis code Z00.129, Encounter for routine child health examination without abnormal findings, is linked to each service reported as this code includes an encounter for developmental screening. Four screening codes you should be using | AAFP

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