Psychiatry Coding & Reimbursement Alert

Published on Thu Aug 02, 2012 PDF

Tip: Check for edits prior to reporting G codes with other services.

As a psychiatry coder, you will often use HCPCS G codes for various screening and counseling services provided by your psychiatrist. The latest round of Correct Coding Initiative (CCI) quarterly edits (ver. 18.2) includes new edits to G codes you may frequently use.

Overview: CCI 18.2, effective July 1, has 2,521 new active pairs and 88 code pair deletions, said Frank D. Cohen, MPA, MBB, senior analyst with The Frank Cohen Group, LLC, in his analysis of the changes. Of the over 2,500 new pairings, 122 had a retroactive effective date of January 1, 2012, while the remaining 2,399 went into effect on July 1. All of the code bundle deletions were effective June 30.

Watch Out for G Code Bundles With Other Psychiatry Codes

According to the newly issued edits, various G codes that you will use for alcohol screening, alcohol abuse counseling, depression screening, and behavioral counseling for prevention of sexually transmitted infections, obesity, and reduction of cardiovascular disease risk will all hit a roadblock if you report these services along with most of the other psychiatry codes.

The following G codes will become column 2 codes for psychiatry codes that you will use. This means that you will not be able to report these codes separately when you report other psychiatry services unless you use a modifier such as 59 (Distinct procedural service):

• G0442 (Annual alcohol misuse screening, 15 minutes)
• G0443 (Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes)
• G0444 (Annual depression screening, 15 minutes)
• G0445 (High intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually, 30 minutes)
• G0446 (Intensive behavioral therapy to reduce cardiovascular disease risk, individual, face-to-face, bi-annual, 15 minutes)
• G0447 (Face-to-face behavioral counseling for obesity, 15 minutes)

The column 1 codes in this edit are very comprehensive and include almost all psychiatry code ranges that you will use in your day-to-day psychiatry practice:

• 90801 -- 90802 (Psychiatric diagnostic or evaluative interview procedures)
• 90804 -- 90815 (Office or Other Outpatient Facility Psychiatric Therapeutic Procedures)
• 90816 -- 90829 ( Inpatient hospital, partial hospital or residential care facility psychiatric therapeutic procedures)
• 90845 -- 90857 (Other psychiatry procedures)
• 90862 -- 90880 (Other psychiatric services or procedures)

Heed These Mutually Exclusive Edits for Alcohol Abuse Screening and Counseling

When your psychiatrist performs health and behavior assessment or intervention and also screens (G0442) or counsels (G0443) for alcohol misuse, you cannot report G codes for alcohol misuse separately, according to version 18.2 of the CCI edits. This is because the codes for health and behavior assessment and these G codes carry the modifier '0' which means that these codes sets are mutually exclusive and cannot be reported together under any circumstance.

The column 1 codes under health and behavioral assessment and intervention include the following:

• 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)
• 96151 (Health and behavior assessment...each 15 minutes face-to-face with the patient; re-assessment)
• 96152 (Health and behavior intervention, each 15 minutes, face-to-face; individual)
• 96153 (Health and behavior intervention, each 15 minutes, face-to-face; group [2 or more patients])
• 96154 (Health and behavior intervention, each 15 minutes, face-to-face; family [with the patient present])

Note: The other screening and counseling codes such as G0444, G0445, G0446 and G0447 are column 2 codes for these above mentioned health and behavioral assessment and interventional codes and carry the modifier '1'. This means that you cannot report these services together when your psychiatrist performs them in the same session unless you append a suitable modifier (such as modifier 59, Distinct procedural service) to distinguish the services performed.

Another set of codes that you cannot report with the G codes for alcohol screening (G0442) and counseling (G0443) are the CPT® codes for alcohol and substance abuse assessment, as these are again mutually exclusive edits as per the v18.2 of the CCI edits. Note that these CPT® codes form the column 2 codes and are not separately reportable:

• 99408 (Alcohol and/or substance [other than tobacco] abuse structured screening [e.g., AUDIT, DAST], and brief intervention [SBI] services; 15 to 30 minutes)
• 99409 (Alcohol and/or substance [other than tobacco] abuse structured screening [e.g., AUDIT, DAST], and brief intervention [SBI] services; greater than 30 minutes)

Reminder: You also cannot use the HCPCS codes G0396 (Alcohol and/or substance [other than tobacco] abuse structured assessment [e.g., AUDIT, DAST], and brief intervention 15 to 30 minutes) and G0397 (...greater than 30 minutes) along with G0443 as these codes are mutually exclusive, as indicated in version 18.2 of CCI.