documentation requirements for cpt code 96160

Complete absence of all Bill Types indicates When more than four CPT codes 96150 are submitted by a provider/group the additional services will be denied. Copyright 2017 by the American Academy of Family Physicians. The CPT Codes discussed in this Billing and Coding Article are used to report the services provided during testing of the cognitive function of the central nervous system. When using Edinburgh Postnatal Depression Screening to screen for depression in pregnant or postpartum patients, it is more appropriate to report CPT code 96160, Administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument. A healthcare provider administers a cardiovascular risk assessment questionnaire to a patient with a family history of heart disease. This Agreement will terminate upon notice if you violate its terms. NCDs do not contain claims processing information like diagnosis or procedure codes nor do they give instructions to the provider on how to bill Medicare for the service or item. Developmental surveillance without use of a structured screening instrument is included in the preventive medicine service and not separately reported. The requirements to report either 96160 or 96161 are as follows: Practice expense is incurred to administer the instrument (such as nurse time or for purchase of the screen). Be sure that your billing staff is aware of National Correct Coding Initiative and other payer edits that may bundle or limit the units of service for screening and assessment codes. 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. If you are experiencing any technical issues related to the search, selecting the 'OK' button to reset the search data should resolve your issues. The following CPT codes associated with the services outlined in this Billing and Coding Article will not have diagnosis code limitations applied at this time. (Monday through Friday, 8:30 a.m. to 5 p.m. Codes 96160-96161 are reported in addition to the evaluation and management (E/M) code (eg, 99213). 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. ). You should not bill 96160 separately when the service is explicitly included in another service being furnished, such as the Medicare AWV. 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. The effective date of this . The healthcare providers analysis of the results and assigned score. Modifier 33 may be required to indicate a service that may be preventive or diagnostic was provided as a preventive service. 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. Sometimes, a large group can make scrolling thru a document unwieldy. Local Coverage Articles are a type of educational document published by the Medicare Administrative Contractors (MACs). . Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. MACs are Medicare contractors that develop LCDs and Articles along with processing of Medicare claims. It is conducted through health focused interviews, observations, and clinical decision making. Here are some hints to help you find more information: 1) Check out the Beneficiary card on the MCD Search page. Draft articles are articles written in support of a Proposed LCD. However, only 96160/96161 involve administering, scoring, and documenting a standardized instrument. A few payers do indicate that a report (separate from the E/M service documentation) is also required, so verify your payers' documentation requirements prior to providing these services. Federal government websites often end in .gov or .mil. 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. If you are acting on behalf of an organization, you represent that you are authorized to act on behalf of such organization and that your acceptance of the terms of this agreement creates a legally enforceable obligation of the organization. All documentation must be maintained in the patient's medical record and made available to the contractor upon request. Your email address will not be published. Further Clarifications on the Use of 96160 and 96161 But you can quickly learn to use screening and assessment codes effectively and accurately. Enter the code you're looking for in the "Enter keyword, code, or document ID" box. Heres your chance to prove you know your way around the F01-F99 codes. End Users do not act for or on behalf of the CMS. damages arising out of the use of such information, product, or process. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement. The physician completes the age- and gender-appropriate history and exam, including a review of the scores of the screening instruments, and provides counseling/anticipatory guidance and/or identifies the need for diagnostic testing as indicated. Applicable FARS\DFARS Restrictions Apply to Government Use. (See last page for instructions. Current Dental Terminology © 2022 American Dental Association. If you would like to extend your session, you may select the Continue Button. 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. Example B: Imagine the same scenario as in example A, but the patient has a different health plan. 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. 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. The purpose of the screening or assessment should guide code selection. 96160 Administration of patient-focused health risk assessment instrument (e.g., . Also, you can decide how often you want to get updates. If you need more information on coverage, contact the Medicare Administrative Contractor (MAC) who published the document. Articles often contain coding or other guidelines that are related to a Local Coverage Determination (LCD). 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. Are HRAs Bundled Into E/Ms or Other Services? All Rights Reserved. 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. The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. The physician provides the age- and gender-appropriate history and examination and briefly discusses the positive depression screening result with the patient. CPT codes 96156, 95158, 96159, 96164, 96165, 96167, and 96168 were added. 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. An annual depression screening of up to 15 minutes is covered for Medicare beneficiaries in primary care settings that have staff-assisted depression care supports in place to assure accurate diagnosis, effective treatment, and follow-up. In this article, we will review the documentation and billing requirements necessary for getting paid. Sign up to receive FPM's free, weekly e-newsletter, "Quick Tips & Insights," featuring practical, peer-reviewed advice for improving practice, enhancing the patient experience, and developing a rewarding career. Coding Guidelines Please contact the Medicare Administrative Contractor (MAC) who owns the document. Forecasting the future is hard []. 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. 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. without the written consent of the AHA. The Medicare program provides limited benefits for outpatient prescription drugs. 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. Documentation in the medical record by the Clinical Psychologist (CP) must include: For the initial assessment, progress notes must include at a minimum the following elements: Onset and history of initial diagnosis of physical illness, and, Clear rationale for why assessment is required, and, Assessment outcome including mental status and ability to understand or respond meaningfully, and. Applications are available at the American Dental Association web site. Article revised and published on 9/9/2021 effective for dates of service on and after 01/01/2020 in response to an inquiry for clarification to the article. A patient with a history of exposure to hazardous chemicals completes an occupational health risk assessment instrument. Goals and expected duration of specific psychological intervention(s), if recommended. 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.. The submitted CPT/HCPCS code must describe the service performed. 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. Please enable "JavaScript" and revisit this page or proceed with browsing CMS.gov with All Medicare beneficiaries who are both: Not within 12 months after the effective date of their first Medicare Part B coverage . Self-Administered Drug (SAD) Exclusion List articles list the CPT/HCPCS codes that are excluded from coverage under this category. Documentation Requirements. Refer to the LCD for reasonable and necessary requirements and limitations. 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. apply equally to all claims. Bulk pricing was not found for item. A patient with a history of smoking completes a lung cancer risk assessment instrument under the guidance of their healthcare provider. You will find them in the Billing & Coding Articles. The AMA does not directly or indirectly practice medicine or dispense medical services. 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. 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). Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, Example: An 18-month-old established patient is seen for a well-child exam. Please visit the. However, services performed for any given diagnosis must meet all of the indications and limitations stated in the LCD, the general requirements for medical necessity as stated in CMS payment policy manuals, any and all existing CMS national coverage determinations, and all Medicare payment rules. The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. Save my name, email, and website in this browser for the next time I comment. Payment policies and claims edits are constantly changing and should be systematically monitored. Please do not use this feature to contact CMS. 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. Codes 96110, 96160, and 96161 are typically limited to developmental screening and the health risk assessment (HRA). If a redetermination is requested, documentation showing the CPT 96160 was added to the Current Procedural Terminology system on January 1, 2017. CPT 96160 is a code used for the administration of patient-focused health risk assessment instruments, including scoring and documentation. Instructions for enabling "JavaScript" can be found here. In most cases, modifiers will override the edits when clinically appropriate. AHA copyrighted materials including the UB‐04 codes and The document is broken into multiple sections. If your session expires, you will lose all items in your basket and any active searches. Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). article does not apply to that Bill Type. 27) Encounter for routine child health exam with abnormal findings Depression Screening (pg. To report, see 96127, 96136, 96137, 96138, 96139. All Rights Reserved. copied without the express written consent of the AHA. 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 Staff administer and score two structured screening instruments for development and autism. All rights reserved. The list of results will include documents which contain the code you entered. 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. Please try reloading page. of every MCD page. Complete absence of all Revenue Codes indicates A neuropsychologist is completing a neuropsychological evaluation. 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). Some payers require reporting 96127 for HEEADSSS and CRAFFT screenings. Organizations who contract with CMS acknowledge that they may have a commercial CDT license with the ADA, and that use of CDT codes as permitted herein for the administration of CMS programs does not extend to any other programs or services the organization may administer and royalties dues for the use of the CDT codes are governed by their commercial license. complete information, CMS does not guarantee that there are no errors in the information displayed on this web site. Codes 96110, 96160, and 96161 are typically limited to developmental screening and the health risk assessment (HRA). This code may also be reported for depression screening in adult patients other than Medicare beneficiaries. What Is a Health Risk Assessment? CPT is a registered trademark of the American Medical Association.". All you have to do is learn the answers to these frequently asked questions. CPT codes 96150 - 96154 are to be billed as one service for each 15 minute of face-to-face contact with the beneficiary(s). This year CPT has added code 99211 to the list and included patient- and caregiver-focused health risk assessment codes 96160 and 96161. However, only 96160/96161 involve administering, scoring, and documenting a standardized instrument. Heres your guide to risk-free screening and assessment coding. To submit a comment or question to CMS, please use the Feedback/Ask a Question link available at the bottom The American Hospital Association ("the AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. 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. All Rights Reserved. Billing and Coding articles provide guidance for the related Local Coverage Determination (LCD) and assist providers in submitting correct claims for payment. 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. 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. G0438 - Initial visit. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or
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