Wiki Codes 96150 - 96155

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Codes 96150 - 96155

Yes. Report codes 96150-96155 for assessing psychological, behavioral, emotional, cognitive, and relevant social factors that can help to prevent, treat, or manage physical health problems. The assessment must be associated with:
• An acute or chronic illness;
• The prevention of a physical illness or disability; and
• The maintenance of health.
The initial assessment (96150 Health and behavior assessment (eg, health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; initial assessment) and re-assessment (96151 Health and behavior assessment (eg, health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; re-assessment) apply to each 15-minute direct, face-to-face session with the patient. Report the reassessment (96151) to obtain objective measures of goals formulated in the initial assessment and to modify plans as is indicated to support the goals.
The following two risk assessment codes were added in 2017:
96160 Administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument
96161 Administration of caregiver-focused health risk assessment instrument (eg, depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument

yankees

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Medicare and Medicaid have new CPT codes 96150-96155 for behavioral assessment and intervention with medically ill patients, can they be used for Outpatient hospital, such as psychology thru a social worker.

Thanks in advance for all the help,
C.U.S.
 

MJ4ever

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Yes.
96150-96151 are reported assessment of psychological, behavioral, emotional, cognitive, and relevant social factors that can help to prevent, treat, or manage physical health problems. The assessment must be associated with an acute or chronic illness, the prevention of a physical illness or disability, and the maintenance of health. The initial assessment (96150) and re-assessment (96151) apply to each 15-minute direct, face-to-face session with the patient. A reassessment (96151) is reported to obtain objective measures of goals formulated in the initial assessment and to modify plans as is indicated to support the goals.

Although it does not directly state in the Coding and Payment Guide for Behavioral Health Services that the Social is allowed this code, we do use these codes for the social workers. To help prove the point, I pulled up the Texas Scope of Practice for Licensed Clinical Social Workers:
Texas State Board of Social Worker Examiners
About the Profession - Scope of Practice





§781.402 The Practice of Professional Social Work

(a) Practice of Baccalaureate Social Work--The application of social work theory, knowledge, methods, ethics and the professional use of self to restore or enhance social, psychosocial, or biopsychosocial functioning of individuals, couples, families, groups, organizations and communities. Baccalaureate Social Work is basic generalist practice that includes interviewing, assessment, planning, intervention, evaluation, case management, mediation, counseling, supportive counseling, direct practice, information and referral, problem solving, supervision, consultation, education, advocacy, community organization and the development, implementation, and administration of policies, programs and activities.

(b) Practice of Clinical Social Work--A specialty within the practice of social work that requires the application of social work theory, knowledge, methods, ethics, and the professional use of self to restore or enhance social, psychosocial, or biopsychosocial functioning of individuals, couples, families, groups, and/or persons who are adversely affected by social or psychosocial stress or health impairment. The practice of Clinical Social Work requires the application of specialized clinical knowledge and advanced clinical skills in the areas of assessment, diagnosis, and treatment of mental, emotional, and behavioral disorders, conditions and addictions, including severe mental illness in adults and serious emotional disturbances in children. The practice of Clinical Social Work acknowledges the practitioners ability to engage in Baccalaureate Social Work practice and Master's Social Work Practice. Treatment methods include the provision of individual, marital, couple, family, and group therapy mediation, counseling, supportive counseling, direct practice, and psychotherapy. Clinical social workers are qualified to use the Diagnostic and Statistical Manual of Mental Disorders (DSM), the International Classification of Diseases (ICD), and other diagnostic classification systems in assessment, diagnosis, and other activities. The practice of Clinical Social Work may include independent clinical practice and the provision of clinical supervision.

(c) Practice of Master's Social Work--is the application of social work theory, knowledge, methods and ethics and the professional use of self to restore or enhance social, psychosocial, or biopsychosocial functioning of individuals, couples, families, groups, organizations and communities. Master's Social Work practice requires the application of specialized knowledge and advanced practice skills in the areas of assessment, treatment planning, implementation and evaluation, case management, mediation, counseling, supportive counseling, direct practice, information and referral, supervision, consultation, education, research, advocacy, community organization and the development, implementation, and administration of policies, programs and activities. The Practice of Master's Social Work may include the Practice of Clinical Social Work under clinical supervision. The practice of Master's Social Work acknowledges the practitioners ability to engage in Baccalaureate Social Work practice.

(d) Independent Non-Clinical Practice --The practice of non-clinical social work outside the jurisdiction of an organizational setting, after completion of all applicable supervision requirements, in which the social worker assumes responsibility and accountability for the nature and quality of the services provided to clients, pro bono or in exchange for direct payment or third party reimbursement.

(e) Independent Clinical Practice--The provision of clinical social work in independent practice wherein the in which the social worker assumes responsibility and accountability for the nature and quality of the services provided to clients, pro bono or in exchange for direct payment or third party reimbursement.


Hope I wasn't over doing it. I am also new to Behavioral Health coding and instead of just giving you a "yes, you can" answer, I have to prove it on paper.

thanks,
Barbara Andrade
 

yankees

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Mrs. Andrade

Mrs. Andrade, i could not have asked for a better more thorough response, thanks so much and good luck with the new Behavioral Health clinic.
take care,
C.U.S.
 

EBRYAN

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Coding for a Clinical Social Worker

I'm getting ready to code for a CSW who sees client with mental not behavior..how would code? The CSw is working under someone else license would that make a different? Help please:confused:
 

EBRYAN

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Coding for a Clinical Social Worker

I'm getting ready to code for a CSW who sees client with mental not behavior..how would I code? The CSW is working under someone else license would that make a different? Help please:confused:
 

MJ4ever

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Hi Ebryan,

For mental health type disorders you would use 90801 for the initial assessment.
For f/u psychotherapy sessions Social workers use 90804 90806 90808 depending on the length of the session. Ask the social workers to always document either the start and end time or the total time of the psychotherapy sessions. That will help support the procedure codes.
90801 is not a time based code so no matter how long the initial assessment is, it will only be 90801.

Hope this helps.
 
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96150 H&B assesment

Coding 96150 with 40 min face to face time documented. Would I code 2 units or 3units?
 
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