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Codes 96150 - 96155

  1. #1
    Default Codes 96150 - 96155
    Medical Coding Books
    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.

  2. #2
    Default
    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
    The Oracle

  3. #3
    Default 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.

  4. Default 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

  5. Default 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

  6. #6
    Default
    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.
    The Oracle

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