routine rating scales

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Anyone have any particular rating scales they use in the outpatient setting? Just asking in general if people are incorporating certain ones routinely in their practice.
 
PHQ
GAD

Bill for them too, 96127.

forums.studentdoctor.net

Brief Emotional-Behavioral Assessment 96127

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...
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Woa, ive been using both of those all the time and I definitely had no idea you could bill for them -_-
 
DrAmazingishere said:
Woa, ive been using both of those all the time and I definitely had no idea you could bill for them -_-
Click to expand...

I'm sure it adds up over time, but it's like $4-5 reimbursement. Some insurances limit how many times you can bill it in a year, I forget what the MUE for CMS is.
 
romanticscience said:
HAMD
YMRS
YBOCS
CAPS
PANSS
ADOS
ASRS

I have them all in a google sheet. PM if interested!
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you're doing routine PANSS in the outpatient setting? Wouldnt that be fairly time intensive or do you get a while for f/u patients?

that is a good point- even for 20 dollars a person, this would add up very quickly if people are filling it out every visit. That would definitely give a nice extra boost, especially if you're doing your own private practice.
 
DrAmazingishere said:
you're doing routine PANSS in the outpatient setting? Wouldnt that be fairly time intensive or do you get a while for f/u patients?

that is a good point- even for 20 dollars a person, this would add up very quickly if people are filling it out every visit. That would definitely give a nice extra boost, especially if you're doing your own private practice.
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It's one I less frequently use. I think it helps me differentiate positive symptoms from mania and negative symptoms from depression.

There are these fairly functional young patients who complain of "depression" and persistent SI which aren't really borderline (e.g., angry, impulsive, interpersonally hypersensitive), chronically score in the moderate range of the HAMD, and who don't really have much "negative affect" (i.e., sadness, misery, guilt). I've been wondering if I'm really seeing some sort of negative symptom schizophrenia or schizotypal personality. For them, I've been tracking their negative symptoms with their depression.
 
What rating scale do people use to track ADHD severity? Using the ASRS, which I know is a screen, doesn't seem to be very sensitive.
 
romanticscience said:
HAMD
YMRS
YBOCS
CAPS
PANSS
ADOS
ASRS

I have them all in a google sheet. PM if interested!
Click to expand...

ADOS...CAPS? That's like 2 hours each to administer, score and make any meaningful interpretation/stuff of that data. And....PANNS and the HAM-D....you in a research study?

I mean....maybe we don't just totally milk it If you can get paid few bucks for interpretation of a PHQ-9 and GAD-7, etc. (which I think is totally ridiculous anyway). Maybe we just stop it there? Maybe we don't totally abuse CPT code 96127?

This is the reason of why Utilization Review (UR) exists within managed care.
 
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erg923 said:
ADOS...CAPS? That's like 2 hours to administer and score and make any meaningful stuff of that data. And....PANNS and the HAMD....you in a research study?

I mean....maybe we don't totally milk it If you can get paid few bucks for interpretation of a PHQ-9 and GAD-7, etc. (which I think is ultimately ridiculous). Maybe we just stop it there? Maybe we don't totally abuse CPT code 96127?
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🙄 spare me the drama. I've seen times when FM/IM literally auto bill 96127 for everyone by handing everyone a PHQ-9 and GAD-7 who comes in for any complaint. Don't think I'll lose any sleep by billing them when I'm actually doing something about the results.
 
The only insurance I take refuses to pay for 96127, so I don't bill it, but I still use a fair number of self-report rating scales, a whole scad at intake and more focused repetitions of some of them at regular intervals to track treatment progression.

The ones I use that I don't see mentioned above are ESS, OCI-R, PCL-5, DAST, IRLS and MSI. Obviously none of the answers of any of these are useful if you don't know how to interpret them and appropriately clarify the responses with the patient but having numbers that actually change can be useful for reassuring yourself (and the patient) that things may actually be getting better in some respect.
 
calvnandhobbs68 said:
🙄 spare me the drama. I've seen times when FM/IM literally auto bill 96127 for everyone by handing everyone a PHQ-9 and GAD-7 who comes in for any complaint. Don't think I'll lose any sleep by billing them when I'm actually doing something about the results.
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Not about what any other specialty may do with the time, son. See above CPT code definitions.
 
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clausewitz2 said:
The only insurance I take refuses to pay for 96127, so I don't bill it, but I still use a fair number of self-report rating scales, a whole scad at intake and more focused repetitions of some of them at regular intervals to track treatment progression.

The ones I use that I don't see mentioned above are ESS, OCI-R, PCL-5, DAST, IRLS and MSI. Obviously none of the answers of any of these are useful if you don't know how to interpret them and appropriately clarify the responses with the patient but having numbers that actually change can be useful for reassuring yourself (and the patient) that things may actually be getting better in some respect.
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"Incidental to"...the primary billing code/encounter.
 
erg923 said:
ADOS...CAPS? That's like 2 hours to administer and score and make any meaningful stuff of that data. And....PANNS and the HAMD....you in a research study?

I mean....maybe we don't totally milk it If you can get paid few bucks for interpretation of a PHQ-9 etc. (which I think is ultimately ridiculous). Maybe we just stop it there? Maybe we don't totally abuse CPT 96127?
Click to expand...

PHQ-9 isn't really meant to track depression and is IMO is crap without clarification. HAM-D and MADRS are more meaningful IMO. And 2 hours to administer a CAPS? That's overkill unless you're trying to document PTSD for forensic purposes. Even evaluating vets trying to get SC can be done easily in less than an hour.
 
Stagg737 said:
PHQ-9 isn't really meant to track depression and is IMO is crap without clarification. HAM-D and MADRS are more meaningful IMO. And 2 hours to administer a CAPS? That's overkill unless you're trying to document PTSD for forensic purposes. Even evaluating vets trying to get SC can be done easily in less than an hour.
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Agree. And Yes! Patients lie...all the time.

Evaluation for service connection is for "forensic purposes." It takes a while (2-6 hours, depending). No. It should not be concluded within an hour.
 
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erg923 said:
Not about what any other specialty may do with the time, son. See above CPT code definitions.
Click to expand...

What about CPT code definitions? I'm not sure you have any idea what you're talking about...probably because you don't bill for these. My point is that there are people who ACTUALLY borderline abuse these codes by having patients fill out a PHQ-9 when they're there for a mole removal.

Here's the newsletter straight from AACAP about utilizing these:


As noted by newsletter as well 96127 also just applies to scoring and documentation of the results, it has nothing to do with interpretation of the tests, which you can actually use as a data point to count towards MDM for the E+M code. Which is why the above PHQ-9 during mole removal visit is technically allowed (they're getting paid for scoring and documenting the PHQ-9, not for actually doing anything about it).
 
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.
 
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I didn't choose them but my organization does PHQ, GAD, CSSRS (if PHQ 9 >= 1), AUDIT. I find the CSSRS really helpful sometimes to cue when I really need to dig into suicidality assessment (or refer to our crisis team.)

Culture here is to use SLUMS even though I prefer MOCA.
 
erg923 said:
Agree. And Yes! Patients lie...all the time.

Evaluation for service connection is for "forensic purposes." It takes a while (2-6 hours, depending). No. It should not be concluded within an hour.
Click to expand...

An hour-ish for a CAPS is reasonable. If there's one clear index trauma, you can probably get it done in about 45 minutes. You're only going well over an hour if there is a very complicated trauma history, or if their response style is problemattic. No one is taking 6 hours to do C&P evals. Heck, since they now farm it out, I'd be surprised if anyone is taking longer than 2 hours, including the report writing at the rates they pay.
 
I use PHQ-9 mainly for patients who are poor historians so it gives me context of why symptoms to look at and address exactly. Like low energy can mean 30 different things, but negative self evaluation more clear cut. I like in the sense that its fast and gives me a quick screening of symptoms that I can address more. Also if someone checks 3 for all them then it gives me an indication they're severely depressed or possibly a bit dramatic.

I like the GAD 7 and PCL as well. In residency they liked the MDQ but I didnt find it useful because I would end up having to bipolar screen and clarify each sx which ended up taking more time.

Love the MOCA, its copyrighted now or am I wrong? I think that change occured a while back while in residency

Also i saw the young mania rating scale but isnt that only used for someone actively manic? I would think that would have more utility in the inpatient setting?

Interesting the variability here in responses
 
DrAmazingishere said:
I use PHQ-9 mainly for patients who are poor historians so it gives me context of why symptoms to look at and address exactly. Like low energy can mean 30 different things, but negative self evaluation more clear cut. I like in the sense that its fast and gives me a quick screening of symptoms that I can address more. Also if someone checks 3 for all them then it gives me an indication they're severely depressed or possibly a bit dramatic.

I like the GAD 7 and PCL as well. In residency they liked the MDQ but I didnt find it useful because I would end up having to bipolar screen and clarify each sx which ended up taking more time.

Love the MOCA, its copyrighted now or am I wrong? I think that change occured a while back while in residency

Also i saw the young mania rating scale but isnt that only used for someone actively manic? I would think that would have more utility in the inpatient setting?

Interesting the variability here in responses
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Have to pay for training to use it now, unless you are exempt. Also, I'm not sure the MoCA technically falls under 96127.
 
WisNeuro said:
An hour-ish for a CAPS is reasonable.
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So even with this lower bound of an hour for the scale, how is anyone using this routinely in an outpatient psychiatric practice?
 
erg923 said:
Agree. And Yes! Patients lie...all the time.

Evaluation for service connection is for "forensic purposes." It takes a while (2-6 hours, depending). No. It should not be concluded within an hour.
Click to expand...

A full, comprehensive PTSD assessment which goes into all aspects of their life will take longer, but spending 2 hours alone on a CAPS is excessive for most individuals unless you're doing it for multiple independent traumas. And sure, SC is forensic, but I was talking more about forensic uses which require comprehensive reports. Which I agree SC evals should be, but the requirements of those evals irl require far less than that. The portion of the evals I was involved in just wanted us to make a diagnosis, evaluate the current severity, and confirm the trauma occurred while active duty. Essentially we were confirming a valid diagnosis and our evals did not determine what %SC they qualified for, which I agree would likely take significantly longer. Again though, that wasn't your initial statement, I'll stand by the opinion that spending 2+ hours on a CAPS regularly means you're extremely inefficient with interviews.
 
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Stagg737 said:
A full, comprehensive PTSD assessment which goes into all aspects of their life will take longer, but spending 2 hours alone on a CAPS is excessive for most individuals unless you're doing it for multiple independent traumas. And sure, SC is forensic, but I was talking more about forensic uses which require comprehensive reports. Which I agree SC evals should be, but the requirements of those evals irl require far less than that. The portion of the evals I was involved in just wanted us to make a diagnosis, evaluate the current severity, and confirm the trauma occurred while active duty. Essentially we were confirming a valid diagnosis and our evals did not determine what %SC they qualified for, which I agree would likely take significantly longer. Again though, that wasn't your initial statement, I'll stand by the opinion that spending 2+ hours on a CAPS regularly means you're extremely inefficient with interviews.
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Agree after being in the hundreds of these that I have administered in clinical and forensic contexts in the past 10+years.
 
I appreciate the other poster's experience with the rating forms. To clarify my purposes, I'm using them to determine the crude efficacy of medications (i.e., no effect, partial effect, full effect) rather than for diagnostic purposes. So, for instance, the CAPS is being used to rate each of the 17? symptoms (0-4). Maybe I should be calling it the PCL-5!
 
romanticscience said:
I appreciate the other poster's experience with the rating forms. To clarify my purposes, I'm using them to determine the crude efficacy of medications (i.e., no effect, partial effect, full effect) rather than for diagnostic purposes. So, for instance, the CAPS is being used to rate each of the 17? symptoms (0-4). Maybe I should be calling it the PCL-5!
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The PCL is the self-report, the CAPS is the structured interview. Are you giving a structured interview every time? You should be calling it whatever instrument that you've administered.
 
WisNeuro said:
The PCL is the self-report, the CAPS is the structured interview. Are you giving a structured interview every time? You should be calling it whatever instrument that you've administered.
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I'm judging the severity rating for each of the symptoms based on the CAPS-5 last month. Thanks for distinguishing that. Any other more clinically practical PTSD scales you recommend?
 
romanticscience said:
I'm judging the severity rating for each of the symptoms based on the CAPS-5 last month. Thanks for distinguishing that. Any other more clinically practical PTSD scales you recommend?
Click to expand...

Are you providing a rating for each item without asking the specific interview questions? If so, I would not do that. If you simply want a measure to track progress over time, give them the PCL to fill out every couple of weeks or month.
 
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