StephY017
New
Hello, still getting my feel of billing. When billing 96127 and 99215 for the same day, should there be a modifier used?
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Wiki Billing 96127
- Thread starter StephY017
- Start date
dbirt13
Contributor
Yes, add 59 modifier to 96127
StephY017
New
Thank you!
alvesey
Contributor
We always use modifier 25 on the E/M code as well.
Pam Warren
True Blue
You need only -25 on the E&M. I would not recommend using -59. Overuse can cause an audit. -59 is when you have more than one procedure; an E&M is not considered a procedure.
Gator
Networker
Would this be correct if billing AAQii, PHQ9 & GAD7 with office visit in primary care. (Other non-MH conditions addressed/managed at visit)
99213-25
96127x3 units
Some sources say -25 on office visit and some sources say -59 on screening
99213-25
96127x3 units
Some sources say -25 on office visit and some sources say -59 on screening
shelpence
New
If a patient come into the office, can you code an E/M as well as G2211 and 96127 when this is done?
Gator
Networker
Answered my own question. This is from a company for Behavioral Health Software
General Billing: Report 96127 in addition to any Evaluation & Management (E/M) or other service when a distinct screening is performed. When billing 96127 on the same day as an E/M visit, attach modifier 25 to the E/M code to indicate a separate service. (The E/M is billed with regular evaluation codes [e.g. 99213-99215, 99385-99395, etc.], plus 96127 on a separate line.) If multiple different instruments are given, bill multiple units of 96127 with modifier 59 (or XE/XS/XU) on the extra units to distinguish them as separate services. For example, if both a PHQ-9 and a GAD-7 are administered, you might report “96127, 96127” with the second unit flagged (59) to avoid bundling edits.
Commercial Insurers: Most major commercial payers do cover 96127 (the code was created to support ACA-mandated screening benefits)