Wiki pp depression

[Korbc]

acog article states
if someone is diagnosed with pp depression we can try to charge for it given payer policy allows. Could we charge if they're not diagnosed with depression but are coming in sooner and more frequently because they have a history of it so they're coming in because of increased personal risk factors?
Also it says......
When using Edinburgh Postnatal Depression Screening to screen for depression in pregnant or postpartum patients, it is more appropriate to report CPT code 96160, Administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument.

If they were diagnosed with the pp depression should I use the above code 96160 or a regular e/m

 

[nielynco]

acog article states
if someone is diagnosed with pp depression we can try to charge for it given payer policy allows. Could we charge if they're not diagnosed with depression but are coming in sooner and more frequently because they have a history of it so they're coming in because of increased personal risk factors?
Also it says......
When using Edinburgh Postnatal Depression Screening to screen for depression in pregnant or postpartum patients, it is more appropriate to report CPT code 96160, Administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument.

If they were diagnosed with the pp depression should I use the above code 96160 or a regular e/m

You can try to bill, but with no depression in evidence you may have an uphill battle getting reimbursed. If she has been diagnosed with depression you would no longer report 96160, but rather a problem E/M code assuming your provider is the one who is treating her for the depression. Remember that once you attached a mental health diagnosis to a service many payers are looking for a different type of provider for the service.

 

[Korbc]

You can try to bill, but with no depression in evidence you may have an uphill battle getting reimbursed. If she has been diagnosed with depression you would no longer report 96160, but rather a problem E/M code assuming your provider is the one who is treating her for the depression. Remember that once you attached a mental health diagnosis to a service many payers are looking for a different type of provider for the service.

thank you so much . When would you charge that 96160 vs. the 0503f? I feel like we do those at all our pp visits. Is that 96160 meant to be charged when someone is getting extra screenings because of a history of personal risk factors that increased the need for their pp visits and then just use the 0503f at the normal 6 week pp visit?

 

[nielynco]

thank you so much . When would you charge that 96160 vs. the 0503f? I feel like we do those at all our pp visits. Is that 96160 meant to be charged when someone is getting extra screenings because of a history of personal risk factors that increased the need for their pp visits and then just use the 0503f at the normal 6 week pp visit?

0503f is a performance measure code that is used to report a PP visit by some Medicaid plans. You will have to access their policy manual on use of this code and perhaps they will also include a list of services included. Code 99160 includes only having the patient or a staff member fill out a self-assessment form (and it can be any kind of health self-assessment form, not just one related only to depression), and does not include physician work (it pays, under Medicare about $3). Another code you might consider for depression screening if the provider is involved in the assessment is 96127 which is specific to depression. If more than one instrument is used and documented, per CPT rules you could report 96127 and 99160 together. But again if you are dealing with a Medicaid billing situation, you need to clarify with them what is acceptable. You would have to be sure the documentation supports the code billed. There is a very good article from 2017 that explains these codes in their CPT context which you might be interested in reading: https://www.aafp.org/pubs/fpm/issues/2017/1100/p25.html

 

[Korbc]

0503f is a performance measure code that is used to report a PP visit by some Medicaid plans. You will have to access their policy manual on use of this code and perhaps they will also include a list of services included. Code 99160 includes only having the patient or a staff member fill out a self-assessment form (and it can be any kind of health self-assessment form, not just one related only to depression), and does not include physician work (it pays, under Medicare about $3). Another code you might consider for depression screening if the provider is involved in the assessment is 96127 which is specific to depression. If more than one instrument is used and documented, per CPT rules you could report 96127 and 99160 together. But again if you are dealing with a Medicaid billing situation, you need to clarify with them what is acceptable. You would have to be sure the documentation supports the code billed. There is a very good article from 2017 that explains these codes in their CPT context which you might be interested in reading: https://www.aafp.org/pubs/fpm/issues/2017/1100/p25.html

thank you so much. When you refer to provider (since sometimes it's used to refer to the practice itself) does the provider for the code 96127 have to be the M.D? what if it was one of our midwives or aprns could i still use it?

 

[nielynco]

thank you so much. When you refer to provider (since sometimes it's used to refer to the practice itself) does the provider for the code 96127 have to be the M.D? what if it was one of our midwives or aprns could i still use it?

The service can be rendered by any billing qualified provider who is performing activities within their scope of practice.

 

[Korbc]

The service can be rendered by any billing qualified provider who is performing activities within their scope of practice.

Thank you so much. I'm not finding 96127 in the book? I assume it's out of sequence but even with that I don't see any notation about it being out of sequence where it would be? What page is 96127 on?

Thanks so much

 

[nielynco]

Thank you so much. I'm not finding 96127 in the book? I assume it's out of sequence but even with that I don't see any notation about it being out of sequence where it would be? What page is 96127 on?

Thanks so much

Yes, it is out of order. You will find it listed after code 96113

 

[Korbc]

Yes, it is out of order. You will find it listed after code 96113

Also could you use 96160 mutilple times during the pp period or those mood check.if they're doing the Edinburgh screening each time and what price would you compare it to or think it should be?
Thank you so much!

 

[nielynco]

Also could you use 96160 mutilple times during the pp period or those mood check.if they're doing the Edinburgh screening each time and what price would you compare it to or think it should be?
Thank you so much!

The number of times you can report a code during a certain time period is always at the discretion of the payer. The instrument you are using must be documented as being medically indicated each time it is used and if you do this to all your patients multiple times during the pp period you may eventually start getting denials. I had previously indicated that Medicare reimburses about $3 for code 99160. How you determine what to charge is up to the practice and your particular costs. It is not appropriate to discuss how to price services or suggest prices for services on this forum.

 

[Korbc]

The number of times you can report a code during a certain time period is always at the discretion of the payer. The instrument you are using must be documented as being medically indicated each time it is used and if you do this to all your patients multiple times during the pp period you may eventually start getting denials. I had previously indicated that Medicare reimburses about $3 for code 99160. How you determine what to charge is up to the practice and your particular costs. It is not appropriate to discuss how to price services or suggest prices for services on this forum.

Thank you so much! Sorry about that! Still learning

 

[nielynco]

Thank you so much! Sorry about that! Still learning

Aren't we all!!!