As of January 1, 2020, CPT made changes to the health and behavior assessment and intervention codes (96150-96155) and therapeutic interventions that focus on cognitive function (97127). If you code and audit services in this category, you must pay close attention to the changes as they include the removal and addition of time-based requirements.
For 2020, CPT added new codes for billing of health behavior intervention services. There is one new code (96156) to report health behavior assessment (HBA) or reassessment and eight new codes (96158, +96159, 96164, +96165, 96167, +96168, 96170 and +96171), four primary and four add-on codes, to report health behavior intervention services. The 2020 changes deleted the codes 96150, 96151, 96152, 96153, 96154, and 96155.
As of this writing in 2019, the assessment codes (96150-96151) are time-based and used to describe services that are intended to assess factors that may affect the recovery or progression of a diagnosed physical health problem or illness. As of 2020, the new assessment code (96156) continues the understanding of the assessment service being an evaluation or reevaluation for the purpose of measuring the patient response(s) to disease or injury, but the new code will no longer be time-based. The assessment includes a health-focused clinical interview, behavioral observations, and clinical decision making. Per CPT guidelines, the focus of the assessment is not on mental health, but on the biopsychosocial factors important to physical health problems and treatments.
The new 2020 intervention service codes (96158-96171) focus on the improvement and management of medical conditions, minimization of psychological and psychosocial impediments to recovery, and improvement of medical conditions. The code options include intervention with the participation of the patient alone, the patient in a group or families with or without the patient. Per CPT guidelines, the focus of the intervention is to improve the patient's health and well-being utilizing cognitive, behavioral, social, and/or psychophysiological procedures designed to ameliorate specific disease-related problems.
On January 1, 2020, CPT will implement changes to the therapeutic interventions that focus on cognitive function and add 97129 and +97130 to replace deleted code 97127 for therapeutic interventions focusing on cognitive (intellectual) function and strategies to manage activities face-to-face with a patient. The two new codes place time limits on the service that were not included with the deleted code; 97129 is for the first 15 minutes, and +97130 is for each additional 15 minutes.
The OIG conducted a study dated June 2019 wherein they indicated that there were approximately $269 million in overpayments for polysomnography services for the period of 2014 through 2015. According to the OIG “These errors occurred because the CMS oversight of polysomnography services was insufficient to ensure that providers complied with Medicare requirements and to prevent payment of claims that didn’t meet those requirements.”
So what are those requirements?
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