ED Coding and Reimbursement Alert

Question: I am looking at an encounter form in which the ED physician counseled a patient with commercial insurance about his drug use for 22 minutes. I am unsure if the session meets CPT parameters for 99408. How can I decide whether to report the counseling code?

Utah Subscriber

Answer: To get paid for 99408 (Alcohol and/or substance [other than tobacco] abuse structured screening [e.g., AUDIT, DAST], and brief intervention [SBI] services; 15 to 30 minutes) and 99409 (... greater than 30 minutes), the ED physician must document a structured screening session and an intervention if the screening is positive. You may not bill the code if both components, screening and intervention, are not provided and documented.

In the 99408 descriptor, CPT specifically mentions a well-known screening tool called the drug abuse screening test (DAST). Check out the Vanderbilt University Addiction Center DAST at http://kc.vanderbilt.edu/Addiction/dast.html.

During the screening session, the physician should have the patient answer specific questions about his drug use, such as:

- Can you get through the week without using drugs?

- Are you always able to stop using drugs when you want to?

- Do you ever feel bad or guilty about your drug use?

- Have you neglected your family because of your drug use?

- Have you been in trouble at work because of your drug use?

- Have you engaged in illegal activities to obtain drugs?

- Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs?

- Have you had medical problems as a result of your drug use (e.g., memory loss, hepatitis, convulsions, bleeding, etc.)?

Looking forward, you might want to confer with physicians to formulate a questionnaire to give to each patient during drug/alcohol counseling sessions.