Otolaryngology Coding Alert

Question: We have a licensed clinical social worker (LCSW) on our staff. Her primary function is to interview our new vertigo patients prior to their visit with the doctor. She sometimes counsels or advises vertigo patients regarding personal problems or coping skills. She also leads a free vestibular-disorders support group for our patients. Is there any way that we can bill for her services? Which codes should we use? Does the doctor have to be on-site?

Oregon Subscriber

Answer: The Medicare Carriers Manual (MCM) includes clinical social workers as nonphysician providers. Therefore, you may report these services either under the social worker's personal identification number (PIN) or "incident-to" the otolaryngologist, as long as state law permits LCSWs to provide these services.

CPT 2002 created new health and behavior assessment/ intervention codes (96150-96155) for patients who have an acute or chronic illness (not meeting criteria for psychiatric diagnosis). The codes cover evaluations that focus on the biopsychosocial factors related to the patient's physical health status, including patient adherence to medical treatment, symptom management and expression, health-promoting behaviors, health-related risk-taking behaviors, and overall adjustment to medical illness.

You cannot use these codes for the initial patient interview because the otolaryngologist must initiate treatment. Regardless of whether the order you mention is convenient, the physician must first see the patient.

If the patient returns on a different day for a health assessment, use 96150 (Health and behavior assessment [e.g., health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires], each 15 minutes face-to-face with the patient; initial assessment). For reassessments, use 96151 ( re-assessment). You may report subsequent counseling sessions as 96152 (Health and behavior intervention, each 15 minutes, face-to-face; individual). For group sessions, use 96153 ( group [2 or more patients]).

If the otolaryngologist is in the office suite when the LCSW renders the services, you may report her services (96150-96153) incident-to the physician's. Otherwise, bill the services under the social worker's PIN.

You may not assign these codes in addition to an E/M code, CPT states. Therefore, if the otolaryngologist provides an E/M service on the same day as an assessment or counseling session, report the primary service only.

Ask your carriers whether they cover the health and behavior assessment/ intervention codes. If they don't, charge the sessions as a cash service. Explain to patients that these are noncovered benefits that your practice provides at the patient's expense.