Difference between G0396 and G0442

jojo1uf

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G0442: Annual alcohol misuse screening, 15 minutes
G0396: Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST), and brief intervention 15 to 30 minutes

I apologize for my ignorance. With regard to Alcohol , what is the difference between G0442 and G0396? Would a physician first perform G0442 in order to determine alcohol "misuse" in the patient. If the patient tests positive for alcohol "misuse", then the physician performs G0396 in order to determine if the patient has an alcohol "abuse" issue?

Any clarification regarding these codes would be greatly appreciated. Thank you!!

Jo:)
 
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G0442: Annual alcohol misuse screening, 15 minutes
G0396: Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST), and brief intervention 15 to 30 minutes

I apologize for my ignorance. With regard to Alcohol , what is the difference between G0442 and G0396? Would a physician first perform G0442 in order to determine alcohol "misuse" in the patient. If the patient tests positive for alcohol "misuse", then the physician performs G0396 in order to determine if the patient has an alcohol "abuse" issue?

Any clarification regarding these codes would be greatly appreciated. Thank you!!

Jo:)

Generally speaking...

G0396/G0397 are SBIRT services - the intent is to identify (screen) patients who are at risk for becoming alcohol dependent, intervene, and then refer to treatment. There are a number of specifics about this service; the screening involves using "validated" and "structured" screening tools that scores the patient, based on those scores, the provider then does a brief intervention and referral. Only certain types of providers are eligible to do these.

Medicare will only pay for these if the service is "to evaluate and/or treat patients with signs/symptoms of illness or injury".

G0442 is just an annual, preventive service, screening, which may lead to the need for a few counseling sessions if the patient tests positive. The patient doesn't need to be exhibiting signs or symptoms, there is no required "brief intervention" and no structured screening tools required.

One wouldn't necessarily have to come before another, although that could certainly happen. However, if a patient is exhibiting signs and symptoms, I think he/she is past what's included in G0442.

Oh, and alcohol misuse is just a polite way of saying alcohol abuse.

https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/Downloads/SE1013.pdf
https://www.cms.gov/Outreach-and-Ed...ducts/downloads/SBIRT_Factsheet_ICN904084.pdf
https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/Downloads/MM7633.pdf
 
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