PDF Coding & Billing Guide December 2018 Updates - NCDHHS How To Use CPT Code 96160 Article document IDs begin with the letter "A" (e.g., A12345). 2) Try using the MCD Search and enter your information in the "Enter keyword, code, or document ID" box. Refer to the LCD for reasonable and necessary requirements and limitations. of every MCD page. DISCLOSED HEREIN. 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. G0439 - Subsequent visit. 21) recommending their use. The CMS.gov Web site currently does not fully support browsers with Do You Have What It Takes to Be a Mental Health Coding Maven? | Terms and Conditions of Use. This procedure includes the administration of the questionnaire, documentation, and scoring. When billing for non-covered services, use the appropriate modifier. This First Coast Billing and Coding Article for Local Coverage Determination (LCD) L33834 Health and Behavior Assessment/Intervention provides billing and coding guidance for frequency limitations as well as diagnosis limitations that support diagnosis to procedure code automated denials. CPT is a registered trademark of the American Medical Association.". DOCUMENTATION GUIDELINES 96110 Each administered developmental screening instrument is accompanied by scoring and documentation (eg, a score or designation as normal or abnormal). 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. Several CPT codes will be permitted through audioonly telehealth after 5/11/2023. Example: An 18-month-old established patient is seen for a well-child exam. Applicable Federal Acquisition Regulation Clauses (FARS)/Department of Defense Federal Acquisition Regulation supplement (DFARS) Restrictions Apply to Government Use. The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. Coding Alert 1: Some payers require reporting 96127 for HEEADSSS and CRAFFT screenings, Hughes notes. You can collapse such groups by clicking on the group header to make navigation easier. 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 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. Procedure Codes for Screening and Assessment Services All Rights Reserved. For this supplementary claims processing information we rely on other CMS publications, namely Change Requests (CR) Transmittals and inclusions in the Medicare Fee-For-Service Claims Processing Manual (CPM). 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. Although the fee-for-service payment for screening and assessments may be small, it can add up to significant income across a patient panel. If you need an accommodation or require documents in another format, please call 1-800-562- 3022. without the written consent of the AHA. 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. You should not bill 96160 separately when the service is explicitly included in another service being furnished, such as the Medicare AWV. The Centers for Medicare & Medicaid Services (CMS), the federal agency responsible for administration of the Medicare, 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. (e.g., transition readiness assessment) with scoring and documentation, per standardized instrument $2.77 NA 0.08 . What Is a Health Risk Assessment? Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. Billing and Coding: Health and Behavior Assessment/Intervention 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). All Rights Reserved. The submitted CPT/HCPCS code must describe the service performed. 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. 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. This article is being retired effective for dates of service on and after 12/08/2022 because the related LCD is being retired. A patient with a history of exposure to hazardous chemicals completes an occupational health risk assessment instrument. Here are some hints to help you find more information: 1) Check out the Beneficiary card on the MCD Search page. 96161 is to be reported to the patient's health plan as it is a service for the benefit of the patient. A patient with a family history of Alzheimers disease completes a cognitive decline risk assessment instrument. 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. The Medicare program provides limited benefits for outpatient prescription drugs. 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. 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). Absence of a Bill Type does not guarantee that the There have been no updates to the code since its addition. 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. 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. 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 can be used for every standardized survey questionnaire if the criteria are established and agreed upon by experts). These materials contain Current Dental Terminology (CDTTM), copyright© 2022 American Dental Association (ADA). Also, you can decide how often you want to get updates. Medicaid plans often allow payment for adolescent HRAs using tools such as the HEE-ADSSS (Home, Education, Eating, Activities, Drugs, Sexuality, Suicide/Depression, Safety) assessment or the CRAFFT (Care, Relax, Alone, Forget, Friends, Trouble) screening tool. Explanation of Revision: Annual 2020 HCPCS Update. Instructions for enabling "JavaScript" can be found here. ICD-10 CM diagnosis code(s) reflecting the physical condition(s) being treated must be present on the claim as the primary diagnosis. CRs are not policy, rather CRs are used to relay instructions regarding the edits of the various claims processing systems in very descriptive, technical language usually employing the codes or code combinations likely to be encountered with claims subject to the policy in question. http://www.cdc.gov/ncbddd/childdevelopment/screening.html 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. No fee schedules, basic unit, relative values or related listings are included in CPT. All documentation must be maintained in the patient's medical record and made available to the contractor upon request. authorized with an express license from the American Hospital Association. PDF EPSDT Program Billing Guide
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