As of Jan. 1, family physicians have two new CPT codes to add to their billing toolboxes: CPT codes 99408 and 99409. The codes were created for physicians to use when billing for alcohol and substance abuse screening and intervention services.
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New Codes Cover Substance Abuse Screening, Intervention
Check Private Payer Coverage Beforehand
By Sheri Porter
Services provided for 15 to 30 minutes can be billed as a code 99408; services provided for more than 30 minutes should be billed as a code 99409. Neither code is designated for use in tobacco screening and intervention services -- those services are reported with codes 99406 or 99407.
Each of the time-based codes can be used in tandem with an evaluation and management code, such as a physician office visit. For example, a patient may present for treatment of a laceration, and during that visit, the physician also can code for counseling the patient about drug or alcohol use.
Despite the possible benefits the new codes may provide, David Ellington, M.D., of Lexington, Va., a member of AAFP's Board of Directors and the Academy's representative to the AMA's CPT Advisory Committee, advised physicians to proceed cautiously. "The great unknown is whether any of the private sector health insurance companies will even pay for these codes if physicians submit them for payment," said Ellington. Before using either of the new codes, physicians should ask private payers with whom they contract if the payers will recognize and pay for the codes, he added.
Physicians also should know that Medicare created its own "G" codes to cover essentially the same services as provided for in the new CPT codes. Physicians must use G code G0396 or G0397 when billing Medicare for alcohol or other substance abuse counseling and intervention services. Medicare created the G codes because it generally doesn't cover screening services for beneficiaries and, thus, eliminated that term from its G code descriptors.
In either scenario, Ellington advised family physicians to carefully document services provided during the office visit. "These are time-based codes that are structured in a very similar pattern as the current Medicare tobacco cessation and counseling G codes," said Ellington. "It is very important that physicians document total time spent in the counseling and interviewing process in the office note. This will save them from any problems in the event of an audit down the road."
Although the new substance abuse screening and intervention codes were first announced by the Office of National Drug Control Policy in October, fee schedules for the new codes were only recently released and, at press time, had not yet been posted on the CMS Web site.
The new codes are being touted as a means to mainstream substance use screening and intervention in health care settings. According to Bertha Madras, M.D., deputy director of the Office of National Drug Control Policy, substance use is "one of the most significant public health challenges in the United States." In an Oct. 11 press release introducing the new health care codes, Madras said that they would "strengthen the doctor-patient relationship" and give physicians the ability to "assess their patients' drug and alcohol use -- as they already do for diabetes and obesity."
Her summation of America's substance abuse problem appears to be on target given highlights gleaned from a recently released report from the Substance Abuse and Mental Health Services Administration. Data from that report -- the National Survey of Substance Abuse Treatment Services: 2006 -- indicates that more than 1.1 million patients in nearly 13,800 U.S. facilities providing substance abuse treatment were receiving treatment on March 31, 2006.
Each of the time-based codes can be used in tandem with an evaluation and management code, such as a physician office visit. For example, a patient may present for treatment of a laceration, and during that visit, the physician also can code for counseling the patient about drug or alcohol use.
Despite the possible benefits the new codes may provide, David Ellington, M.D., of Lexington, Va., a member of AAFP's Board of Directors and the Academy's representative to the AMA's CPT Advisory Committee, advised physicians to proceed cautiously. "The great unknown is whether any of the private sector health insurance companies will even pay for these codes if physicians submit them for payment," said Ellington. Before using either of the new codes, physicians should ask private payers with whom they contract if the payers will recognize and pay for the codes, he added.
Physicians also should know that Medicare created its own "G" codes to cover essentially the same services as provided for in the new CPT codes. Physicians must use G code G0396 or G0397 when billing Medicare for alcohol or other substance abuse counseling and intervention services. Medicare created the G codes because it generally doesn't cover screening services for beneficiaries and, thus, eliminated that term from its G code descriptors.
In either scenario, Ellington advised family physicians to carefully document services provided during the office visit. "These are time-based codes that are structured in a very similar pattern as the current Medicare tobacco cessation and counseling G codes," said Ellington. "It is very important that physicians document total time spent in the counseling and interviewing process in the office note. This will save them from any problems in the event of an audit down the road."
Although the new substance abuse screening and intervention codes were first announced by the Office of National Drug Control Policy in October, fee schedules for the new codes were only recently released and, at press time, had not yet been posted on the CMS Web site.
The new codes are being touted as a means to mainstream substance use screening and intervention in health care settings. According to Bertha Madras, M.D., deputy director of the Office of National Drug Control Policy, substance use is "one of the most significant public health challenges in the United States." In an Oct. 11 press release introducing the new health care codes, Madras said that they would "strengthen the doctor-patient relationship" and give physicians the ability to "assess their patients' drug and alcohol use -- as they already do for diabetes and obesity."
Her summation of America's substance abuse problem appears to be on target given highlights gleaned from a recently released report from the Substance Abuse and Mental Health Services Administration. Data from that report -- the National Survey of Substance Abuse Treatment Services: 2006 -- indicates that more than 1.1 million patients in nearly 13,800 U.S. facilities providing substance abuse treatment were receiving treatment on March 31, 2006.
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