Wiki 96127/brief emotional/behavioral assessment

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L
Is there any type of crosswalking tool offered at this site. We got a new encoder at our hospital
that does NOT crosswalk CPT codes to ICD 10 PCS codes. Just wondering. Thank You.

NaylinG

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Debry, FL
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Hi,
I have been trying to get guidelines in regards of how to bill for this and the only thing that I have found so far is the description, but nowhere tells me the standars or how often can it be use. Can somebody point me to the correct place? Thank you:)
 

lockmand

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Hi- I'm also having issues on finding any information on how to properly bill for cpt 96127 - are there specific documentation requirements needed to bill for this code and is there a limitation? I have seen different threads where people are saying you can only bill up to 4 times, but from what authoritative source did this come from? Thanks.
 

redtnc

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Fremont, NE
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I'm in the same situation. I've researched this quite a bit but am unable to find anything regarding the actual documentation required. We scan the depression screen but does the provider need to document a detailed assessment or can you bill for just doing the screen? Any info. would be greatly appreciated!
 
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96127

Hi,

For most payers, no report is required for use of a standardized instrument to assess emotional/behavioral status because the code descriptor states, with scoring and documentation, to indicate that no physician work (interpretation and report) was included in the value of services reported with this code. However, watch for certain payers that have interpreted the guidelines for central nervous system tests given in the prefatory text in this section of CPT. These payers won't cover the assessments unless the physician documents a brief report (e.g., score and interpretation based on patient presentation). The Medicaid Medically Unlikely Edits assign 2 units of service to code 96127 so additional medically necessary units (e.g., ADHD instrument completed by parent and two teachers) must be reported on separate claim lines (e.g., 2 units, 1 unit with modifier 59). For payers who use Medicare's MUE, only two units will be paid and others will be denied but you can appeal. Other payers have developed their own edits like United Healthcare's Maximum Frequency Per Day edits that also allow 2 units per day for 96127.

Bottom line, watch the payer's policies for this code.

Hope that helps.
Cindy
 
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