Wiki Depression Screening to Commercial Payers

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ksanthony

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I would like to know if any practices submit CPT code G0444, with modifier 59 for depression screenings; using screening tools such as the PHQ-9 to commercial plans. The test is scored, reviewed and a plan is documented by the provider. I understand that this code is to be used for Medicare patients / claims, but I would like to know if anyone has submitted it to BCBS of Alabama, BCBS Federal, United Healthcare, Aetna, or Humana for instance, and been paid.
 
ksanthony said:
I would like to know if any practices submit CPT code G0444, with modifier 59 for depression screenings; using screening tools such as the PHQ-9 to commercial plans. The test is scored, reviewed and a plan is documented by the provider. I understand that this code is to be used for Medicare patients / claims, but I would like to know if anyone has submitted it to BCBS of Alabama, BCBS Federal, United Healthcare, Aetna, or Humana for instance, and been paid.
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We do not use G0444 for commercial plans & Medicaid, we use 96160 with dx Z13.31.
 
Hi Rhomas,
Why would you not use a definitive dx ranging from F32-F34 as first dx code then add dx Z13.31 as 2nd dx code for CPT 96160?
I am just curious
Lady T
 
Hi RThomas
I would then use the documentation to support the dx so can use the CPT 96160. Does patient cry or very sad or worried or tried to commit or spoke of suicide or try harm self then see dx R44 to R45. These dx are supported from in the documentation from provider or social worker on why pt getting health assessment CPT 96160.
Well hope this helps you somewhat. If the treating clinician does not document properly or describe care given nothing can do
Lady T
 
TThivierge said:
Hi RThomas
I would then use the documentation to support the dx so can use the CPT 96160. Does patient cry or very sad or worried or tried to commit or spoke of suicide or try harm self then see dx R44 to R45. These dx are supported from in the documentation from provider or social worker on why pt getting health assessment CPT 96160.
Well hope this helps you somewhat. If the treating clinician does not document properly or describe care given nothing can do
Lady T
Click to expand...
There is documentation to support. We utilize the PHQ9 screening assessment which is reviewed, scored and the provider initials the assessment. Depression screening starting at age 11 is recommended by the AAP Bright Futures guidelines. It's also a requirement of Medicaid wellness visits if you are an EPSDT provider and some other payers.
 
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Hi RThomas
So what your telling me is they just do the assessment PHQ9 but do not say F32 or F41 as dx if patient condition warrants it? Where I work they do many types of mental health questionnaires but always follow it up with an assessment/dx code plus their other chronic conditions. Very seldom use Z dx code as first dx unless it is a FIRST listed dx code. I think some of the payers are aware of the Z dx code placement on claim per the ICD10 manual.
Ok thanks for responding ...have a good day!
Lady T
 
TThivierge said:
Hi RThomas
So what your telling me is they just do the assessment PHQ9 but do not say F32 or F41 as dx if patient condition warrants it? Where I work they do many types of mental health questionnaires but always follow it up with an assessment/dx code plus their other chronic conditions. Very seldom use Z dx code as first dx unless it is a FIRST listed dx code. I think some of the payers are aware of the Z dx code placement on claim per the ICD10 manual.
Ok thanks for responding ...have a good day!
Lady T
Click to expand...
If the assessment turns out to be positive then they will address it and use appropriate dx, for example F41.1. If the screening is negative then Z13.31 is used. When it comes to wellness/preventative visits Z codes are sometimes the only codes associated with the visit.
 
You would want to check the payer's policy for how they expect these screens to be submitted.

Usually it's in a preventive services or screening policy. Examples: This is an old post, but has good info. https://www.aafp.org/pubs/fpm/issues/2017/1100/p25.html
"Payment policies and claims edits are constantly changing and should be systematically monitored. Many payers and clearinghouses offer code edit simulators for use in determining whether codes for services such as screenings and assessments are bundled or separately paid."
 
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