Medicare Compliance & Reimbursement

Doctor must document time, structured questionnaire

Heads up: If a patient comes in and seems to have substance-abuse issues, then you may have an opportunity to bill an extra code in addition to the evaluation and management visit.

The lowdown: You can bill new substance abuse screening codes 99408-99409 in addition to a separately identifiable E/M visit.

You'll probably use these codes mostly in the primary care and pain management settings, says Joan Gilhooly, president of Medical Business Resources in Barrington, IL.

Example: A patient comes in for a refill of a controlled-substance medication, and the physician performs an E/M visit about the patient's underlying condition that is causing pain. The physician recognizes the patient is "taking part in drug-seeking behavior" and takes advantage of the opportunity to evaluate the patient, says Gilhooly.

You could also see patients coming in who show signs of abusing illegal drugs or alcohol, or who have failed a drug test, say experts.

Whether Medicare will pay for these codes is not yet clear, but because the White House Office of National Drug Control Policy pushed for them, they're likely to receive some payment.

The codes are time-based, with 99408 representing a session from 15 to 29 minutes, and 99409 covering 30 minutes or more. So you should make sure your physician is noting how long the substance abuse screening lasted.

What to document: You can't bill 99408-99409 unless your physician documents a structured screening session, say experts. This should include specific questionnaires, either in writing or verbally.

The physician may also take part in a brief intervention that goes beyond simply advising the patient to stop abusing substances.

ONDCP recommended that doctors use a tool like the Drug Abuse Screening Test which includes questions like:

• 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 due to 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 drug use (e.g., memory loss, hepatitis, convulsions, bleeding)? "Doctors will now be able to assess their patients' drug and alcohol use--as they already do for diabetes and obesity--and work to prevent, reduce and treat those with substance abuse disorders," said ONDCP deputy director Bertha Madras in a release.

An estimated 22 million Americans have problems with drugs or alcohol, or are addicted, and 95 percent of them are unaware they meet the clinical criteria for substance abuse or addiction, said [...]