ED Coding and Reimbursement Alert

Question: We saw a patient for a panic attack who revealed a cocaine addiction. The ED physician documented that he advised the patient to stop using drugs. Should we bill this service with 99406 or is there another appropriate code?

Codify Subscriber

Answer: No. You would not report 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) for an alcohol and substance abuse screening and intervention. You should only report 99406 for smoking and tobacco-use cessation counseling.

You have a separate set of codes to choose from for alcohol and/or substance abuse:

• 99408 (Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes)
• 99409 (… greater than 30 minutes).

However, to appropriately report 99408 and 99409, the physician must document the time he spent with the patient and meet the minimum time requirements, which you didn’t mention.

According to the CPT^® guidelines, you should report 99408 if the provider spends 15 to 30 minutes screening a patient for abuse of alcohol or another non-tobacco substance. You would report 99409 if the provider spends more than 30 minutes screening a patient for abuse of alcohol or another non-tobacco substance. With both codes, the physician performs a brief intervention at the same session for the patient. The preamble to this code family reads, “Behavior change services involve specific validated interventions of assessing readiness to change and barriers to change, advising a change in behavior, assisting by providing specific suggested actions and motivational counseling, and arranging for services and follow up.” As such, documentation would require more than advising the patient “to stop using drugs” to legitimately report the service.

Don’t miss: For Medicare patients, you may consider reporting G0396 (Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes) or G0397 (… greater than 30 minutes) in place of 99408 or 99409.

Caution: You should never report 99408 in conjunction with 99409. You should also never report 99408 or 99409 in conjunction with 96160 (Administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument) or 96161 (Administration of caregiver-focused health risk assessment instrument (eg, depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument).