Brief Emotional-Behavioral Assessment 96127

[Sushirolls]

My understanding is this can be submitted for reviewing and documenting results of the PHQ-9 and GAD-7. And submitted for each assessment. Even for the columbia suicide screen.

Have others used this yet or learned anything about its documentation needs in order to submit? Low lying fruit, but I do like to get paid for the work I do.

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[WisNeuro]

I think this is worth 0 wRVUs, and a pretty negligible facility/nonfacility RVU rate. Also, the MUE is set at 2, so if you want to bill it more than twice, be prepared to do extra documentation and still run the risk a good deal of the time that the billing would be denied.

 

[Sushirolls]

Medicare rate for an approximation of projections ~$7.50.
Let's use the figure of ~400 pts per full time outpatient psychiatrist.
Psychiatrist see's patients at least once a year, performs a PHQ-9 and GAD-7, documents, and bills.

400 patients x 2 scales x $7.50 reimbursement rate = $6000

 

[WisNeuro]

So, could make a small chunk. Go for it. As far as I know, this was not one of the codes that was changed when they redid most of the assessment codes for 2019. Just make sure it's not double dipping with another code. Also, I don't think it's limited to one set a year for each patient. Last I checked it was only limited to 2 units per visit, although may want to check the new guidelines to see if they left that the same. If that's the case, why not have the patient do them at every check in, in the waiting room, briefly discuss, have an auto-populating note, and there you go.

 

[Sushirolls]

Just got an EOB from one insurance company. Amount billed for 2 units of 96127 was 100% discounted. Called them up, and stated it was considered a "bundled service" with the 90792 code on same day of service. This company is already a lower paying one that many other psychiatric providers locally don't accept, so not surprised by this behavior. My discussion with company about billing with 99205 instead and was told "may be covered." Then the possibility of billing 96127 on a different day of service from 90792, and "yes, it would be covered."

 

[Sushirolls]

So I'll call that insurance company X1. It appears 96127 is consistently not reimbursed whether with 90792, 99205, 99213/4, and on the same day of service or separate day. X1 just won't pay.

Company X2 denied a same day of service with a 99205 & 99354.

 

[Sushirolls]

Looking like 90792 paired with any insurance for 96127 gets denied, including medicare.

However, medicare will pay ~$10 with a 99204 code.

 

[Sushirolls]

One higher paying insurance is also variably reimbursing for this code, too. ~$10 Whether paired with 90792 or not. And variably with 99213 or 99214.

 

[Sushirolls]

In grand summary, 4 higher paying insurance companies and medicare are paying for this code.
2 less than medicare paying insurance companies are not.

I recently acquired records from a local Big Box shop and one of their PCPs was billing out this code for their PHQ, too.

 

[Sushirolls]

Still using the code pretty consistently, and usually doing two. One for a GAD-7 and one for a PHQ-9. Going well.
Dropped one of the insurance companies that wasn't paying for it.

 

[clausewitz2]

Still using the code pretty consistently, and usually doing two. One for a GAD-7 and one for a PHQ-9. Going well.
Dropped one of the insurance companies that wasn't paying for it.

Oh man, I had no idea this was a possibility. I get fairly regular GAD7 or PHQ9 on like half of my panel, and some kind of standardized self report measure (problem specific) on half of the rest. I will report back how this goes, could be a significant chunk of change

 

[Sushirolls]

Oh man, I had no idea this was a possibility. I get fairly regular GAD7 or PHQ9 on like half of my panel, and some kind of standardized self report measure (problem specific) on half of the rest. I will report back how this goes, could be a significant chunk of change

Remember the modifier 25 / 59 in using this
99214 25
96127 59
96127 59

And also have a phrase similar to using 90833 to support it as a 59 in your A/P. something like I ordered this, reviewed it, resulted it and my interpretation is Yepper and clinically means Yahooooo!

 

[calvnandhobbs68]

Oh man, I had no idea this was a possibility. I get fairly regular GAD7 or PHQ9 on like half of my panel, and some kind of standardized self report measure (problem specific) on half of the rest. I will report back how this goes, could be a significant chunk of change

Yeah I’m planning to start billing this soon as well. It already looks like UBH doesn’t cover it based on my contract with them but not sure about other insurers yet.

AACAP actually had a newsletter about this code specifically encouraging people to bill it since it theoretically should encourage people to get measurements more frequently. When I looked at that it looked like some private insurers would pay up to 4x per year per patient for it.

 

[clozareal]

I don't use 96110 (developmental screening), 96127 (brief emotional/behavioral assessment), or 96161 (patient caregiver assessment for benefit of patient which is common in CAP) since we don't get reimbursed for them. Most insurances won't cover for 96136 for 2 or more tests anymore, but Medicare will until the end of 2021 at least.

I do use 96130 once at the start of treatment when I'm interpreting their intake questionnaires but can't use it regularly which comes out to an additional 2.56 RVUs.

 

[splik]

I don't use 96110 (developmental screening), 96127 (brief emotional/behavioral assessment), or 96161 (patient caregiver assessment for benefit of patient which is common in CAP) since we don't get reimbursed for them. Most insurances won't cover for 96136 for 2 or more tests anymore, but Medicare will until the end of 2021 at least.

I do use 96130 once at the start of treatment when I'm interpreting their intake questionnaires but can't use it regularly which comes out to an additional 2.56 RVUs.

96130 is for psychological testing. Looking at intake questionnaires definitely does not count for this. That is part of the E&M. You could use 96127 for the screeners (like you said if you are RVU based there’s no wRVUs for it) but if you’re not doing psychological testing you don’t have any justification for using 96130. It would be very unusual for a non psychologist to use this code since most physicians aren’t trained in psychological testing

 

[clausewitz2]

Update: I began putting down one unit of 96127 for patient encounters in which I did legitimately use validated rating scales and/or screeners and added clinical interpretations of each. My one insurance payor rejected all of them because they do not pay for 96127 in general. It was a good dream while it lasted.

I don't plan to stop using the rating scales or screeners at all because I was using them regardless before I even became aware of this code but there is a frisson of resentment now for sure.

 

[calvnandhobbs68]

Alright gonna try billing 96127 this week with one insurer. I'm doing 2-3 units per intake. I looked at the insurers charge sheet and technically they should pay for the code (looks like around 5 bucks a unit) so if they reject it I'll be rather annoyed.

 

[TexasPhysician]

I don't use 96110 (developmental screening), 96127 (brief emotional/behavioral assessment), or 96161 (patient caregiver assessment for benefit of patient which is common in CAP) since we don't get reimbursed for them. Most insurances won't cover for 96136 for 2 or more tests anymore, but Medicare will until the end of 2021 at least.

I do use 96130 once at the start of treatment when I'm interpreting their intake questionnaires but can't use it regularly which comes out to an additional 2.56 RVUs.

Do screening tests meet criteria for 96136?

 

[calvnandhobbs68]

Do screening tests meet criteria for 96136?

Generally probably no

CPT code 96136 is used when tests are administered by a physician or other qualified healthcare professional and is defined as “Psychological or neuropsychological test administration/scoring by physician or other qualified healthcare professional, two or more tests, any method; first 30 minutes”. Note specifically that this code requires that at least 2 tests are administered and that they may be administered using any method. You also have to spend at least 16 minutes on this based on the half time point criteria.

So no self administered measure meets criteria. If you were doing something like a clinician administered YBOCS for instance, I think that might count more but this is really designed to code for things like neuropsych testing. Now if you want to take the time to go through a whole screening measure yourself x2 with a patient and spend at least 16 minutes on it sure. But if you look at the reimbursement you’re gonna get paid a lot less than using that time other ways.

 

[calvnandhobbs68]

Update:

2/5 of my major insurers are paying for 96127, about 5 dollars per unit on average it seems, based on the reports I'm getting from my group. Seems they will pay for up to 3 units per encounter but I'm still not sure the max number of units they'll do a year (so if they'll pay for a PHQ-9 every visit or not). Only way to figure it out is going to be trying to track per patient which is gonna be painful.

United BH isn't right now, which is interesting because of the big lawsuits they've had recently. One other major insurer in my area isn't as well but they pay more than average for followups in general so I don't care that much (more than enough difference to make up for the scales).

Still waiting to see for my last insurer since I just got paneled on them most recently so just started submitting charges for those patients a couple weeks ago.

 

[Sushirolls]

I've not had any unit limitations per annum. Bill it every time I do it.

Recently had one big national company actually start paying for them when they hadn't before.

Medicare has an annual limit, I can't recall how much, I just bill it anyways and if not paid, so be it.

The large (lawsuit filled company...) that I recently dropped was the only that didn't cover it.

 

[Stagg737]

Is this a code that can be utilized on an inpatient unit? I realize it probably wouldn't be reimbursed every day, but could it be billed on intake and day of discharge?

Found an FAQ with the below additional info, but couldn't find anything other than it's recommended for outpt PCP visits:
- Can use 2 codes per visit and most insurances will accept it up to 4x per year. CMS does not limit annual uses, but max 2 codes per visit.
- CMS reimbursement average is $4.89 per 96217
- 96217 has been permanently approved for telehealth visits

 

[trixter888]

Sorry to hijack the thread but I am getting a little lost with the coding referenced in the thread.
Can someone explain the following and which I should be using?

99217 59 (looks like this is the one we can use up to twice per encounter for PHQ-9 and GAD-7? What is the 59 for?)
99214 25 (I know what 99214 is but what is the 25 add on after mean?)
96136
96130

BTW not sure if mentioned under another thread but my PCP friend also mentioned using 99406 for smoking cessation so I am trying to incorporate that.

Thanks!

 

[Dr. ADT]

If someone uses scales in their assessments, does that help in qualifying for 99214?

 

[Sushirolls]

25 and 59 and GT and 95 and QW are what are referred to as modifiers.

If you bill a 99214 it stands alone with no modifiers.

If you wish to bill 99214 and 90833 for the same encounter you would do:
99214 25
90833 59


If you did this encounter as telemedicine:
99214 25, 95
90833 59, 95

Some insurance will want the telemedicine encounter using a different code:
99214 25, GT
90833 59, GT


Let's say you also have a CLIA lab (with appropriate certification) and bill for 80305
99213 25
90833 59
96127 59
96127 59
80305 QW

CMS created a standard form, a way with which all data of an encounter shall be submitted to an insurance company. The CMS 1500 form.
Section 24, under box D you will find where CPT codes and the modifiers go.

Also be aware on the Section 24, under box B is the Place of Service. 11 denotes the usual outpatient office. Some insurance companies are okay with using 11 as the POS, with a 95 modifier above for telemedicine. Other insurance companies want you to use GT and the POS to be 02.

Also be aware on the Section 24, under box E is the diagnosis code 'linkage' where you will link up which diagnosis goes to which code. For instance you will likely associate A, B, C, D diagnosis for the 99214, but perhaps only B, C for 96127, and only D for 80305.

Still scratching your heads out there in SDN land? Google "CMS 1500 form" and then click on images and look at some random samples.
*you don't need every box filled in.
*you only need some boxes filled in.
*you'll learn what the minim is to submit a claim with experience.

 

[Sushirolls]

99406 like 96127 need a good description in your note saying white it is separate from the main E&M, what was done, and time spent on it, blah, blah, etc.
I have a template phrase I use when doing nicotine cessation counseling. A few insurance companies in my area cover it, some don't.

 

[Sushirolls]

This won't mean much to most folks unless you actually doing your own billing...

But this kernel of billing wisdom is rather than doing 2 units under Section 24 Box G, I've found its easier/better to submit as a whole 'nother line rather than doing 2 units. This goes for 96127 and 99417.

The things you learn.

 

[Sushirolls]

If someone uses scales in their assessments, does that help in qualifying for 99214?

Nope.

They should be separate.

Thus, why on the billing they are billed with a modifier denoting they separate, and your documentation should reflect they are separate.

 

[calvnandhobbs68]

Nope.

They should be separate.

Thus, why on the billing they are billed with a modifier denoting they separate, and your documentation should reflect they are separate.

I don’t think they HAVE to be separate in the note. Interpretation can be incorporated into the E+M service and as long as the instrument is documented in the medical record somehow, that’s all the justification that would be needed in an audit to prove you actually did it.

This is on one of the billing guidelines for 96127:

Clinical staff (e.g. registered nurse) can administer and score the completed instrument while the
mid-level provider or physician incorporates the interpretation component into the
accompanying E/M service.

 

[Sushirolls]

Most likely is sufficient. These days I just don't trust insurance companies, so I took the documentation a step further.

Create a blurp more in the Plan section of the note:
Distinct from the E&M, ordered and administered a PHQ-9, results were suggestive of OMG, but clinically it correlates more towards meh with influences from country song lyrics

Basically showing true homage that this is different and not just part of the E&M, and no doubt what-so-ever, clearly indicated by how its written above. Probably overkill but makes me feel better.