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Substance Use Disorder Coding

Melissa Posted Thu 02nd of January, 2020 15:33:46 PM
Hello, we have a substance abuse outpatient clinic that has just recently become credentialed to bill insurance, Medicare and Medicaid; We have several questions: 1 Can the Alcohol and/or drug assessment be billed on the same date as an E&M visit? Can those be billed when provided by a Case Manager or Peer Support under the supervision of a Physician or LCSW? If a physician and a LCSW see the patient on the same date, can both services be billed?
SuperCoder Answered Fri 03rd of January, 2020 05:47:47 AM

Hi Melissa,

 

Thanks for your question.

 

  1. There is CCI edit between drug abuse assessment code (e.g. G0396 or 99408) and evaluation and management codes (e.g. 99201-99215). This means these cannot be report together. If the provider performs screening and decides the patient does not require an intervention, then screening can be included the in the selection of the E/M code.
  2. If a Case Manager or a Peer Support is authorized to provide a particular service, then this can be billed as “incident to” service when provided under the supervision of a physician.
  3. If a physician and a LCSW see the patient on the same date, they can bill their own services separately. Clinical social workers may bill Medicare Part B and be reimbursed for approved services. The benefit differs for therapists and clinical social workers. Due to statutory provisions, physical therapists, occupational therapists, and clinical social workers may:
    1. Bill directly for services they personally perform, or,
    2. Have their services billed incident to the services of a physician/NPP. However, the benefit for their services does not allow them to bill for the services of staff furnished as an incident to the services that they personally provide.

 

Please feel free to write if you have any question.

 

Thanks

Melissa Posted Fri 03rd of January, 2020 09:33:07 AM
Thank you very much!
SuperCoder Answered Sun 05th of January, 2020 23:57:22 PM

Thank you, happy to help.

Melissa Posted Wed 08th of January, 2020 16:22:19 PM
Hello, I have a couple of more questions in follow up.....In number 3 of your response, would the same apply if a Physician and a Psychologist saw the patient on the same date? Can they both bill for their services? Also our local medicaid plan says they require the HF modifier on every claim; would that be the case for most commercial payers as well and does it need to be on all codes on the claim? Thank you
SuperCoder Answered Thu 09th of January, 2020 07:08:39 AM

Please find answers to your questions:

 

  1. If a Physician and a Psychologist saw the same patient on the same date and provided different services, then they both can bill for their own services separately.
  2. You may report Modifier HF for Medicaid claims. Modifier HF denotes services provided to a participant in a substance abuse program. Specific use of the HF modifier varies depending upon the program and its sponsoring agency and payer. This is not a common modifier. Medicare does not recognize this modifier. See payer guidelines for specific codes that require or are eligible for the HF modifier.

 

 

Hope this helps.

 

Thanks

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