Description
Fall 2009 SODBP Newsletter
Coding Conundrums
By Lynn M. Wegner, MD, FAAP
This column will be a little different as I want to let our readers know what is developing in the AAP coding world relevant to our particular interests in providing developmental and behavioral care for our patients. The AAP Committee on Coding and Nomenclature (COCN) has many other ongoing activities, but I will describe the ones in which I have been intimately involved. While NONE of these proposals have been accepted yet –I wanted you to know what is currently being worked on!
Many medical providers had needed a procedure code to describe the service of screening a family member of the patient for emotional or behavioral concerns. Possibly the most prominent example of this would be screening a new mother for post-partum depression. The COCN submitted a proposal to the American Medical Association’s Current Procedural Terminology (CPT) Editorial Panel to revise existing CPT code 99420 (administration and interpretation of a health risk assessment instrument (eg, health hazard appraisal.)While the original intent behind code 99420 is to assess whether a patient is exhibiting behaviors that could put them in a higher risk category for developing a new health disorder or exacerbating a health condition already identified, COCN wanted to revise the code descriptor to allow use of a standardized health risk assessment instrument on the guardian and/or caretaker of the patient. The CPT Editorial Panel will consider our request during its October 2009 meeting.
The revised 99420 code includes its application to a caretaker of the patient and clearly defines the service as describing the administration and interpretation of a single instrument. The model for this proposed change is CPT code 96110(developmental testing, limited), where the screening instrument is administered and scored by someone other than the physician and the interpretation of the screening tool and recording of the results are included as part of the evalaution and management service. Like 96110, the revised 99420 code permits the reporting of multiple screening instruments on a single date of service. Each is interpeted and this interpretation and proposed intervention must then be recorded in the patient’s medical record.
For the coding savvy, the question could be asked: “How is this new wording change different from CPT code 96150(Health and behavior assessment (health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires, each 15 minutes, face-to-face with the patient, initial assessment)?” CPT code 96150 is for an assessment service provided to the patientand not a caretaker.
Don’t hold your breath while waiting for this to occur –CPT 2011would be the soonest that we could have any final action on this proposed change.
The second topic involves screening for behavioral and emotional conditions in the patient. At this time, a code specifically for this type of screening does not exit. Those of us who do this screening have been using CPT code 96110 Developmental Screening, Limited. As the faithful readers of this column know, this code may be used in multiple units on a date of service and there is no physician work involved. The code is for the administration and scoring of the instrument by someone other than the physician as the physician service of interpretation and recording of the results is included in the E/M service.
So, I developed a proposal for a new code to describe behavioral and emotional patient screening using validated instruments, but an interesting thing happened as I was writing it up. I was deciding on the instrument examples I wanted to use in the descriptor and I started looking up the descriptors. What I found is that some scales were developed to be used as broad screeners while others were clearly narrower in their scope. They were developed to hone in on a diagnosis –taken in context, of course, with the patient’s history and clinical interview. Then others could be used to monitor treatment efficacy. Interestingly, I could find no practical overview reviews of instruments from the standpoint of selecting one meeting a specific need.
What I decided from my review, was to develop a family of codes addressing behavioral and emotional conditions. The first would address my first intention: broad screening to identify those individuals who might have one or more disorders and need further examination. The second code would be for those narrow band rating scales useful as part of a diagnostic process and also for monitoring treatment effectiveness.
I will be submitting these proposals to the other members of the COCN during its November 2009 meeting. I’ll keep you apprised of the progress of the 99420 proposal and status of the behavioral/emotional screening codes. If you have comments or suggestions for these or other code topics, please don’t hesitate to let me know:
lwegner@med.unc.edu.
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Publication date: Dec 11, 2009
Revise date: Dec 11, 2009
TextID: 695
