New Behavior Assessment Codes for Telehealth

New Behavior Assessment Codes for Telehealth

Here’s why you shouldn’t use these codes for physician services … ever.

There’s a slew of new health behavior assessment codes for 2020 and, good news, they’re on Medicare’s list of services you can provide via telehealth during the public health emergency (PHE) for COVID-19.

Check out this rundown of the new codes and who should be using them.

Assessment Codes Include Individual, Group

The health and behavior assessment and intervention services new for 2020 are:

  • 96156 Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)
  • 96158 Health behavior intervention, individual, face-to-face; initial 30 minutes
  • 96164 Health behavior intervention, group (2 or more patients), face-to-face; initial 30 minutes
  • 96167 Health behavior intervention, family (with the patient present), face-to-face; initial 30 minutes
  • 96170 Health behavior intervention, family (without the patient present), face-to-face; initial 30 minutes
  • +96159 Health behavior intervention, individual, face-to-face; each additional 15 minutes (List separately in addition to code for primary service)
  • +96165 Health behavior intervention, group (2 or more patients), face-to-face; each additional 15 minutes (List separately in addition to code for primary service)
  • +96168 Health behavior intervention, family (with the patient present), face-to-face; each additional 15 minutes (List separately in addition to code for primary service)
  • +96171 Health behavior intervention, family (without the patient present), face-to-face; each additional 15 minutes (List separately in addition to code for primary service)

“These codes replace six older codes to more accurately reflect current clinical practice that increasingly emphasizes interdisciplinary care coordination and teamwork with physicians in primary care and specialty settings,” according to the American Medical Association.

For Medicare, 96158 through +96168 can be audio-only services. Codes 96170 and +96171 have no such information in the Medicare-approved code list, so you may want to check with your individual payers before using one of these codes to report an audio-only telehealth service.

Use Codes for NPPs Only

The new CPT® codes are for only nonphysician practitioners who cannot report their own evaluation and management (E/M) services. Use of these codes to represent work by a physician or other qualified healthcare provider (QHP) who could report an E/M code will be met with denial, according to the American Psychiatric Association (APA).

“Health behavior assessment and/or intervention services performed by a physician or other QHP who may report E/M services should do so using codes found in the E/M Services or Preventive Medicine Services sections of the CPT® Manual,” according to the APA’s Crosswalk for 2020 Health Behavior Assessment and Intervention CPT® Codes.

The codes that physicians and QHPs should report for health behavior assessment and intervention are typically 99401 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes through 99412 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 60 minutes, depending on encounter specifics.

Codes 96156 through +96171 are for services provided to patients who have a primary physical illness, injury, diagnosis, or symptoms and who could be aided in recovery from psychological/psychosocial assessments and interventions related to the health issue. These assessments can include promotion of functional improvement; examining and minimizing psychological/psychosocial barriers to recovery; and management of and improved coping with medical conditions.

Mind These Reporting Rules

A few tips for using 96156 through +96171 :

  • Do not report 96158, 96164, 96167, or 96170 for less than 16 minutes of service.
  • Do not report +96159, +96165, +96168, or +96171 as standalone codes; you must use them in conjunction with the base codes associated with them.
  • Do not report 96156, 96158, +96159, 96164, +96165, 96167, +96168, 96170, or +96171 in conjunction with 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, or 0373T.

Remember that, although the new codes will remain in effect until otherwise revised or deleted, coverage for performing them via telehealth may end when the PHE for COVID-19 ends.


Sources:

https://www.ama-assn.org/press-center/press-releases/ama-releases-2020-cpt-code-set#:~:text=Additional%20CPT%20changes%20for%202020,96165%2C%2096168%2C%2096171

https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes/

https://www.apaservices.org/practice/reimbursement/health-codes/crosswalk.pdf

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Chris Boucher, CPC
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Chris Boucher, CPC, has 10 years of experience writing various newsletters and other products for The Coding Institute. His blog covers several areas of coding and compliance, including CPT® coding, modifiers, HIPAA compliance, and ICD-10 coding.

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