What is the difference between G0444 and 96127 for depression screening, and where does it indicate who can use it? Am I missing something in the coding description?
I work for an insurance company and am being instructed to setup G0444 to be allowed for depression screening for any diagnosis. That means if a provider bills G0444, regardless of diagnosis, G0444 will pay 100%, without assessing member's deductible or charging the member, as this is considered a preventive benefit.
I'm being asked to setup 96127 for depression screening requiring diagnosis Z13.32, which I understand, as 96127 seems to be pretty broad. If a provider bills 96127 with Z13.32, it would pay 100% per preventive care benefits.
This is where it gets confusing. I was also asked to setup 96127 for depression screening with diagnosis Z13.31, for only members under 21. That means if a provider bills 96127 with Z13.31 for an adult, the claim will pay less, and the member might get charged. It appears that the provider is supposed to know that for non-pregnant adults, they need to know to bill G0444. Can someone verify that this is true? We do not have a policy setup that mentions this, and aren't allowed to explain to providers what the correct code is when they call in to appeal denials. I am wondering if this criteria is standard and I am missing something, because I don't agree with the other coder's decision.
Thank you!
I work for an insurance company and am being instructed to setup G0444 to be allowed for depression screening for any diagnosis. That means if a provider bills G0444, regardless of diagnosis, G0444 will pay 100%, without assessing member's deductible or charging the member, as this is considered a preventive benefit.
I'm being asked to setup 96127 for depression screening requiring diagnosis Z13.32, which I understand, as 96127 seems to be pretty broad. If a provider bills 96127 with Z13.32, it would pay 100% per preventive care benefits.
This is where it gets confusing. I was also asked to setup 96127 for depression screening with diagnosis Z13.31, for only members under 21. That means if a provider bills 96127 with Z13.31 for an adult, the claim will pay less, and the member might get charged. It appears that the provider is supposed to know that for non-pregnant adults, they need to know to bill G0444. Can someone verify that this is true? We do not have a policy setup that mentions this, and aren't allowed to explain to providers what the correct code is when they call in to appeal denials. I am wondering if this criteria is standard and I am missing something, because I don't agree with the other coder's decision.
Thank you!