ED Coding and Reimbursement Alert

Question: Can we report services involving behavior modification counseling in the ED? What are the general requirements for these types of services?

Texas Subscriber

Answer: You can if you meet the requirements of the counseling risk factor reduction and behavior change intervention in CPT^®.   These codes (99406-99409) describe face-to-face services provided by a physician or other qualified healthcare professional.  In the ED setting, as in other sites of service, the emergency physician utilizes a standardized evidence-based screening instruments and tools with reliable documentation and appropriate sensitivity, which are required in order to report any of these services (e.g., AUDIT, DAST and T-ACE for alcohol, etc.). Medicare does not recognize the CPT® codes and requires use of the HCPCS codes G0396-G0397 instead.

Remember: The minimum time thresholds must be met in order to report the behavior change intervention codes. See the chart below:

Caveat: Although the visit to the ED might be an excellent opportunity to conduct these interventions, especially if substance abuse was the direct cause of the visit, these codes require a significant amount of time and additional skill beyond general advice provided to patients. Make sure you have truly met the requirements before reporting the code separate from the E/M service.