Primary Care Coding Alert

Question: A 9-year-old diabetes patient refuses injections because of pain. Our diabetes nurse performs an assessment interview and teaches the child proper technique and biofeedback to reduce her symptom. How should I code the nurse's service?

Louisiana Subscriber
 
Answer: You should report health behavior assessment intervention code 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 the nurse's initial assessment. The health and behavior assessment/intervention codes (96150-96155) appropriately describe services that nonphysicians provide for patients with established illnesses, such as diabetes mellitus (e.g., 250.03, Diabetes mellitus without mention of complication; type I [insulin dependent type] [IDDM] [juvenile type], uncontrolled).

You should report 96150 for each 15-minute increment. If the nurse spends 30 minutes assessing the patient's behavior and teaching the child ways to ameliorate her disease-related problems, you should bill 96150 x 2.

For subsequent visits, you should use the re-assessment (96151, ... re-assessment) or intervention (96152, Health and behavior intervention, each 15 minutes, face-to-face; individual) codes, which you should also report per 15- minute segment.