Wiki Phq-9 and gad-7

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t.rodgers@nwbchcc.org

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Hello ,

I am in need for some help. My BH providers are doing PHQ-9 and GAD-7. I read that these codes are replaced by 96127. However, my BH providers state they are different and want to know if we can get paid for both codes. I have read that 96127 include PHQ-9, PHQ-A and GAD-7. If my BH provider is doing a GAD-7 and a PHQ-9 can I bill out 96127 and up the units to 2 for reimbursment? Not sure since I am not a coder and my billing manager has quite on me. Left in the dark with this.

Tammy
 
Same exact question!

I see you posted a few months ago on this topic. I have the same question as we typically give both the PHQ-9 and GAD-7 to many of our patients. When I simply send in two charge lines, I am getting the 2nd one rejected as a duplicate. Let me know if you have figured this out.

Thanks!
 
I do know you can up the units to 2 on 96127 and receive payment. We recently have done this and are seeing reimbursement.

However, I have a question along the same lines... would you bill the 96127 or the 96160? I am trying to figure out what the difference between these two codes are. Someone decided to bill 96127 for our GYN patients and 96161 for our OB patients. I know the 96161 is incorrect but now I am stuck as to what the difference between the 96127 and 96160 is. We are using both the PHQ-9 and the GAD-7.
 
PHQ-9 and GAD-7

Hello,

96127 is a time-based code which require documentation of start and stop time. This is info from FindACode:

"Emotional/behavioral assessments may be performed by medical and mental health professionals in the clinical setting and also by trained professionals in the educational setting. These assessments gather information regarding feelings and emotions and problem behaviors through direct observation of the individual and/or questionnaires completed by the individual, caregivers, teachers, and others. Areas assessed can include activities of daily living (ADL), relationships, attitude, adaptability, aggression, anxiety, attention, atypicality, conduct problems, depression, functional communication, hyperactivity, social skills, somatization, withdrawal, and self-esteem. Assessment tools may include the Behavior Assessment System for Children-Second Edition (BASC-2), Behavior Rating Profile-Second Edition (BRP-2), Child Behavior Checklist (CBCL), Conners' Rating Scale, Pervasive Developmental Disorder Behavior Inventory (PDDBI), Brief Infant Toddler Social Emotional Assessment (BITSEA) and the Patient Health Questionnaire for Depression and Anxiety (PHQ-4, PHQ-9).

The individual tests can take from 10-45 minutes to complete with additional time allocated for the results to be compiled and scored.


Code 96127 can be applied for each standardized test that is administered, scored, and reported. 96127 is billed for each test, it is a timed code stating individual tests can take from 10-45 min to complete. AMA states you cannot bill for time less than 31 minutes and “A minimum of 31 minutes must be provided to report any per hour code.”

To use modifier 59, documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. If two timed services are provided in blocks of time that are separate and distinct (i.e., the same time block is not used to determine the unit of service for both codes), modifier 59 may be used to identify the services.

Instead of using modifier 22, it would be appropriate to report one more unit if it the time was over 1.31 minutes."


Hope this helps!

Nancy
 
PHQ9 and GAD7

nkroche said:
Hello,

96127 is a time-based code which require documentation of start and stop time. This is info from FindACode:

"Emotional/behavioral assessments may be performed by medical and mental health professionals in the clinical setting and also by trained professionals in the educational setting. These assessments gather information regarding feelings and emotions and problem behaviors through direct observation of the individual and/or questionnaires completed by the individual, caregivers, teachers, and others. Areas assessed can include activities of daily living (ADL), relationships, attitude, adaptability, aggression, anxiety, attention, atypicality, conduct problems, depression, functional communication, hyperactivity, social skills, somatization, withdrawal, and self-esteem. Assessment tools may include the Behavior Assessment System for Children-Second Edition (BASC-2), Behavior Rating Profile-Second Edition (BRP-2), Child Behavior Checklist (CBCL), Conners' Rating Scale, Pervasive Developmental Disorder Behavior Inventory (PDDBI), Brief Infant Toddler Social Emotional Assessment (BITSEA) and the Patient Health Questionnaire for Depression and Anxiety (PHQ-4, PHQ-9).

The individual tests can take from 10-45 minutes to complete with additional time allocated for the results to be compiled and scored.


Code 96127 can be applied for each standardized test that is administered, scored, and reported. 96127 is billed for each test, it is a timed code stating individual tests can take from 10-45 min to complete. AMA states you cannot bill for time less than 31 minutes and “A minimum of 31 minutes must be provided to report any per hour code.”

To use modifier 59, documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. If two timed services are provided in blocks of time that are separate and distinct (i.e., the same time block is not used to determine the unit of service for both codes), modifier 59 may be used to identify the services.

Instead of using modifier 22, it would be appropriate to report one more unit if it the time was over 1.31 minutes."


Hope this helps!

Nancy
Click to expand...

I sent you a PM about this.
 
PHQ-9 and gad 7

twizzle said:
I sent you a PM about this.
Click to expand...

Where do you see it saying the 96127 is time based? My books shows only select codes in that category is face to face and those are the ones that require a minimum of 31 mins to bill it. I don't see where the 96127 is time based, can you let me know we do these in our office quite a bit.

Thanks,
Dawn
 
The code 96127 is on CMS's Physician Fee Schedule with an indicator of 0- for Multiple. And on CMS's MEU (Medically Unlikely Edits) table they do list this code with the max. number of units for a calendar day as 2-BUT the MUE also list this with an indicator 3. MAI 3 indicates a value that is "Unlikely" to appear on a correctly coded claim but could, in unusual circumstances, may be payable.
You might want to use the quantity of 2 cautiously. Perhaps verify the supporting documentation demonstrates there were two separately identifiable procedures and they were medically necessary, -then you should be ok.
 
It may help to double-check that each claim line is linked to the appropriate diagnosis code. Since the MUE for 96127 is two, claims with two units of service should not deny but check the reimbursement policies of individual health plans.

Also, if billing with screening diagnosis codes, you may be denied when billing for anxiety screening because it is not a recommended preventive service. Screening for depression is recommended for patients 12 and over but only once per year.

Hope that helps.
Cindy
 
This is a really late comment, but CPT does not indicate 96127 or 96110, to be time-based in 2019 CPT guidelines, see page 714. It is based on unit per instrument, there are other similar codes that ARE time based, ex. 96112, 96113, 96116, 96130, 96131, 96132 96133,96136, 96137, 96138, these are based on hour or per 30 min.
 
What happens when it is a Medicare patient. I have been instructed to use G0444 for the depression screening, but, the provider is doing a GAD-7 also? Can G0444 be billed with quantity as well or is there a different HCPCS code for the GAD-7?
 
The GAD-7 is part of the depression screening service, and wouldn't be billed separately. Most self-assessments, particularly one that is only 7 questions, do not get special billing.
 
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