Getting Paid for Screening and Assessment Services
If you're not coding and billing for these services, you might be leaving money on the table.
Fam Pract Manag. 2017 Nov-Dec;24(6):25-29.
Author disclosure: no relevant financial affiliations disclosed.
Recent changes to CPT codes for structured screenings and brief assessments have led some payers to expand coverage for these services. If you are not billing for these services, you may be losing out on valuable revenue. Quality initiatives may include incentives for performing and reporting recommended screenings and assessments, which provides an additional reason to familiarize yourself with these codes. In this article, we will review the documentation and billing requirements necessary for getting paid.
Correct coding and documentation
Four codes are used to report structured screening and assessments:
96110, “Developmental screening (e.g., developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument,”
96127, “Brief emotional/behavioral assessment (e.g., depression inventory, attention-deficit/hyperactivity disorder scale), with scoring and documentation, per standardized instrument,”
96160, “Administration of patient-focused health risk assessment instrument (e.g., health hazard appraisal) with scoring and documentation, per standardized instrument,”
96161, “Administration of caregiver-focused health risk assessment instrument (e.g., depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument.”
Codes 96110, 96160, and 96161 are typically limited to developmental screening and the health risk assessment (HRA). However, code 96127 should be reported for both screening and follow-up of emotional and behavioral health conditions.
The purpose of the screening or assessment should guide code selection. To see a description of each code and examples of standardized instruments that may be used for each, see “Quick reference: Screening and assessment codes.” CPT Assistant has described a standardized instrument as a “previously validated test that is administered and scored in a consistent or ‘standard’ manner.” Validated structured instruments have been shown through study to provide consistent and reliable results.
These codes do not represent physician work. For payment purposes, each screening and assessment code was valued based on practice expense and professional liability only, which includes the cost of furnishing instruments (when applicable) and staff time to administer and/or score an instrument for the physician or other qualified health care professional's review. The physician's interpretation of the score in light of the patient presentation is considered part of the evaluation and management (E/M) service, which would be billed in addition to the screening or assessment code.
Documentation of a structured
1. National Academy for State Health Policy. The Nuts and Bolts of Medicaid Reimbursement for Developmental Screening: Insights from Georgia, Minnesota, and North Carolina. 2016. http://nashp.org/wp-content/uploads/2016/09/Screening-Brief.pdf. Accessed Oct. 24, 2017.
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