Wiki question

[jwayne65]

I work for a pain specialist in O.P.,Ks. I was told by another physicians office we could bill cpt code 96103 for giving a patient an Opioid Risk Tool (or OTR ), which is about 5-6 questions.
I am wondering if anyone else has done this?

 

[JenniferB7]

The screening is part of the same day E/M service. If you provided at least 15 minutes of intervention, in addition to the screening, you can report:

• CPT 99408 if you administered a screening and had to provide 15-30 minutes of intervention services (i.e., counseling) or 99409 for 30+ minutes (see CPT parenthetical notes - state only to use for the initial screening & intervention); or
  
  • Medicare: G0396 (15 to 30 minutes);
  • Medicaid: H0050 (per 15 minutes);
  
  
• CPT codes 99401-99404 for preventive medicine counseling and/or risk factor intervention(s), if you meet the requirements.

In either case, make sure the screening and intervention is separately documented, including time, and not counted towards the level of E/M service. You will need a modifier 25 on the E/M service if it is separate and distinct from the intervention services.

Hope that helps!