Wiki 96127 and 96160

[gcohen]

What ICD 10 covers these screening at 100%, generally. I know payers vary. 96160 for adolescents and maternal depression screenings.

Thanks!

 

[erinperez_81@hotmail.com]

Did you ever get an answer as to what ICD 10 to use when billing 96127?

 

[dineshkumar.p7@accesshealthcare.com]

for 96160 we have to use dx Z13.39 -Encounter for screening examination for other mental health and behavioral disorders. pt focused health risk assessments like alcohol, drug abuse etc.

What ICD 10 covers these screening at 100%, generally. I know payers vary. 96160 for adolescents and maternal depression screenings.

Thanks!

 

[dineshkumar.p7@accesshealthcare.com]

Did you ever get an answer as to what ICD 10 to use when billing 96127?

for screening purpose we have to code Z13.31(for adult), Z13.32(for maternal patient), for diagnostic purpose we have to code F90.X(ADHD), F32.X, F33.X(depression dx), F41.X(Anxiety). Hope it helps..

 

[erinperez_81@hotmail.com]

Thanks!!! Do you include modifier 59 on 96127 claims? Also for Medicare do you bill G0444 instead of 96127 and does that need modifier 59?

 

[erinperez_81@hotmail.com]

Also, are there any payers that you know for a fact do not reimburse for 96127 and is there a visit limit per year for this code. I am seeing some payers pay it often, others say it's limited to 4x per year.

 

[dineshkumar.p7@accesshealthcare.com]

Thanks!!! Do you include modifier 59 on 96127 claims? Also for Medicare do you bill G0444 instead of 96127 and does that need modifier 59?

yes for medicare are billing G0444 instead of 96127. for commercial payors based on medical record(PHQ and GAD assessment) we are billing 96127 in 2 separate line items and give modifier-59 in second line items(for example, 96127(1st line item), 96127 with modifier-59 (second line item).

 

[dineshkumar.p7@accesshealthcare.com]

Also, are there any payers that you know for a fact do not reimburse for 96127 and is there a visit limit per year for this code. I am seeing some payers pay it often, others say it's limited to 4x per year.

we have to check payor reimbursement policy.

 

[erinperez_81@hotmail.com]

yes for medicare are billing G0444 instead of 96127. for commercial payors based on medical record(PHQ and GAD assessment) we are billing 96127 in 2 separate line items and give modifier-59 in second line items(for example, 96127(1st line item), 96127 with modifier-59 (second line item).

Can you tell me why you are billing the 96127 on two seperate line items so I can try it? Is one of them getting paid when you do it this way? We are finding that 96127 does not pay when billed on the same claim as 99406.

 

[dineshkumar.p7@accesshealthcare.com]

Can you tell me why you are billing the 96127 on two seperate line items so I can try it? Is one of them getting paid when you do it this way? We are finding that 96127 does not pay when billed on the same claim as 99406.

yes, CPT Code 96127 is a component of Column 1 code 99406 and cannot be billed using any modifier on the same claim due to NCCI edits. in this scenario we cannot bill both together.