documentation requirements for cpt code 96160 documentation requirements for cpt code 96160

Because of the impact on the medical management of the patients disease, documentation must show evidence of coordination of care with the patients primary medical care provider or medical provider responsible for the medical management of the physical illness that the psychological assessment/intervention was meant to address. 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. The AMA does not directly or indirectly practice medicine or dispense medical services. It is worth the effort to determine which payers in your area pay for these services. MACs can be found in the MAC Contacts Report. 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. ICD-10 webpage for individual CRs and coding translations for ICD-10 and . Separate billing for scoring and report preparation is not allowed. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. 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. Use of structured instruments for assessing attention deficit should be linked to the ICD-10 code for the diagnosis or symptoms that prompted the assessment. This year CPT has added code 99211 to the list and included patient- and caregiver-focused health risk assessment codes 96160 and 96161. CMS believes that the Internet is will not infringe on privately owned rights. Neither the United States Government nor its employees represent that use of such information, product, or processes This blog is not intended to provide medical, financial, or legal advice. The instrument is scorable. Changes to CPT codes for structured screenings and brief assessments have led some payers to expand coverage for these services. In most instances Revenue Codes are purely advisory. 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. It is conducted through health focused interviews, observations, and clinical decision making. There have been no updates to the code since its addition. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. Try entering any of this type of information provided in your denial letter. A patient with a family history of Alzheimers disease completes a cognitive decline risk assessment instrument. 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. This is particularly true if the physician routinely screens every patient for depression. damages arising out of the use of such information, product, or process. http://www.cdc.gov/ncbddd/childdevelopment/screening.html You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement. 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. For purpose of this exclusion, "the term 'usually' means more than 50 percent of the time for all Medicare beneficiaries who use the drug. The submitted medical record must support the use of the selected ICD-10-CM code(s). . Coding Alert 1: Some payers require reporting 96127 for HEEADSSS and CRAFFT screenings, Hughes notes. How Do 96160/96161 Differ From Other Screening and Assessment Codes? Explanation of Revision: Annual 2020 HCPCS Update. 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. Report ICD-10 code Z13.89, Encounter for screening for other disorder, in conjunction with depression screening services. What Counts as a Standardized Instrument? All rights reserved. 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. Washington Apple Health means the public health insurance programs for eligible Washington residents. 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. Reproduced with permission. A score is assigned to the patients health risk based on the assessment instruments criteria. 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. Clarification was made to the Health and behavioral assessment and Health and behavioral intervention. DOCUMENTATION GUIDELINES 96110 Each administered developmental screening instrument is accompanied by scoring and documentation (eg, a score or designation as normal or abnormal). 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.. Codes 96110, 96160, and 96161 are typically limited to developmental screening and the health risk assessment (HRA). Another option is to use the Download button at the top right of the document view pages (for certain document types). Applicable FARS/HHSARS apply. CPT code 96160 allows allergists to get reimbursed when they make use of certain standardized asthma assessment instruments. Are HRAs Bundled Into E/Ms or Other Services? 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). All other Codes (ICD-10, Bill Type, and Revenue) have moved to Articles for DME MACs, as they have for the other Local Coverage MAC types. Flexibility #6 17 18 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. Copyright © 2022, the American Hospital Association, Chicago, Illinois. article does not apply to that Bill Type. 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). CDT is a trademark of the ADA. 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 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. Documentation Requirements. CPT codes 96158, 96164, and 96167 should not be reported for less than 16 minutes of service. 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. This code may also be reported for depression screening in adult patients other than Medicare beneficiaries. 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. recommending their use. 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. (For more information, see Screening Your Adult Patients for Depression, FPM, March/April 2016.) CPT Code 96160 may not be used to claim a stand-alone administration of a CRAFFT (CPT Code 96127) brief screen. without the written consent of the AHA. To see a description of each code and examples of standardized instruments that may be used for each, see Quick reference: Screening and assessment codes. CPT Assistant has described a standardized instrument as a previously validated test that is administered and scored in a consistent or standard manner. Validated structured instruments have been shown through study to provide consistent and reliable results. Heres your guide to risk-free screening and assessment coding. 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 Agreement will terminate upon notice if you violate its terms. 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.