Wiki 96127

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lburgos31

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Chester, PA
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Does anyone know if Mental health providers (psychologist/trist) can bill 96127? We used to bill it with a 90846 or 90847 years ago, but we now know they are bundled. Has anyone billed this code on its own on a separate claim? or the day prior or the following day of the therapy visit? Any feedback is appreciated!
 
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Is this for Aetna? The only E/M we bill are clinical intakes, and we usually use 96127 as screening tool during a course of therapy which is why we used to bill it with 90846 or 90847... i was thinking about billing it with a 59 but the NCCI edits have a "zero" for modifier usage right?
 
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The provider is a Psychiatric Mental Health Nurse Practitioner; when she does patient medication management she uses 99214 with the 96127 x2. The second 96127 we append modifier 59 because it will be associated with a different diagnosis. I did not see any NCCI edit alerts for the way were billing it. Were located in Wisconsin and most of the insurances we are billing have been paying on it, I couldn't tell you if Aetna was specifically one of the insurance.
 
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I was under the impression that Behavioral Health providers could not bill a 96127 because their assessment was included in their psychiatric evaluation. I thought that 96127 was used by providers normally in PCP Clinics. I'd love to know more about billing this code if we can, in fact, bill it. Thank you for any help!
 
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I know it can get paid with the right modifiers, but has anyone been audited on it by any payer? I don't see how it can be "separate and identifiable" from the reason the patient is getting medication management from a behavioral health provider. I would think that best practices would dictate that it can't.
 
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