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96127 Clarification

kym Posted Thu 24th of October, 2019 09:01:12 AM
hello, I am an LCSW, I'm getting conflicting information about 96127, the brief assessment code. Is it true that I can use this code for up to 4 brief psychological assessments per day and potentially use it for every date of service that I see my client or is it only 4 times a year? Do I need a modifier? Do I bill it with 90837 on the same claim form? If so, just place it on the next line of the claim form? Everywhere I read there is different conflicting info. I'm trying to use this code with telehealth sessions. So, Location 02, 90837, modifier GT, Any clarification would be greatly appreciated.
SuperCoder Answered Fri 25th of October, 2019 07:42:07 AM

Hi.

 

As per the American Academy of Pediatrics (AAP),

The frequency of reporting 96127 (emotional/behavioral assessment) is dependent on the clinical  situation. The AAP Bright Futures “Recommendations for Preventive Pediatric Health Care” schedule  recommends developmental/behavioral surveillance at each preventive medicine visit, and a formal  assessment (eg, PHQ-2) for depression is recommended at every annual visit beginning at age 11 with a  validated/standardized assessment instrument to improve detection of depression at the earliest possible  age to allow for appropriate intervention services.     Thus, the use of assessment instruments as a screening mechanism seems to enhance the task of  identifying those who may be suffering from an emotional or behavioral disorder.  The exact frequency of  testing therefore depends on the clinical setting and the provider’s judgment as to when it is medically  necessary. When physicians ask questions about a patients emotional or behavioral health as part of the  general informal history (eg, surveillance), this is not a formal "screen" as such, and is not separately reportable. 

There are some payers which says, 96127 can be billed up to 4 times per year, with a maximum of 4 different screens per visit, but this may vary based on insurance provider.

 

Please check the below link:

https://www.aap.org/en-us/Documents/coding_factsheet_developmentalscreeningtestingandEmotionalBehvioraassessment.pdf

 

 

As per the CCI edits, the modifier indicator for CPT 90837 and 96127 is ‘0,’ which means that you cannot unbundle the codes using any modifiers. Since the emotional/ behavioral assessment code 96127 is the column 2 code, you cannot report 96127 with 90837 (Psychotherapy, 60 minutes with patient) code for the same patient on the same calendar date of service.

 

Please check the below link:

https://www.supercoder.com/coding-newsletters/my-psychiatry-coding-alert/cci-21-0-update-zero-in-on-cci-bundles-affecting-your-behavioral-assessment-reporting-144978-article

 

Thanks

 

kym Posted Mon 28th of October, 2019 10:35:27 AM
Ok thank you. So how do I actually bill for this on a HCFA 1500 form? Do I bill line one, 90837 then on the next line 96127 and then just bill the charge for each service? Is this saying I do not need to use a modifer on the claim form if I bill them like this? Thank you in advance. I am a therapist, not a biller and I'm trying to understand in layman's terms.
SuperCoder Answered Tue 29th of October, 2019 10:31:29 AM

Hi,

 

Both codes cannot be billed together on the same date of service as per CCI edits due to bundling issues which cannot be bypassed even when appending modifiers with the CPT code. Therefore, please bill CPT code 90837 only on the HCFA 1500 form. Also, if the procedures have been performed in different POS (Place of service), codes should be billed on different claims. However, both codes can be billed if the services have been performed on different date of services. 

 

Thanks

kym Posted Tue 29th of October, 2019 10:36:02 AM
Ok, so bill 96217 all by itself on a separate HCFA form even if you did another service on that date? I would typically do a 90791 or a 90837 on the same day I would be doing the brief assessment associated with the 96127? I'm sorry, I'm not getting it the way you are explaining it.
SuperCoder Answered Wed 30th of October, 2019 07:57:11 AM

Hi, 

 

We appreciate your patience.

 

Please provide more clarity on below:

  • CPT codes 96127 and 90837 were performed on same date or on different dates.
  • >CPT codes 96127 and 90837 were performed at same place of service (POS) or at different POS.

 

>Thanks

 

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