Pediatric Coding Alert

Question: As a part of the Medicare Meaningful Use program, we routinely screen mothers of patients for maternal depression. We have been using 96161 with Z13.89 but have recently been denied. Is this the correct way to bill for this service?

Massachusetts Subscriber

Answer: Your use of CPT^® code 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) is absolutely correct, as unlike 96160 (Administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument), it documents that the screening is for the caregiver and not for the patient.

However, there are several potential problems here that you should take up with your payer to find out why it denied this claim. Using Z13.89 (Encounter for screening for other disorder) for the maternal depression screening is an older way of documenting the encounter. Last October, however, saw the introduction of a new ICD-10 encounter code, Z13.32 (Encounter for screening for maternal depression), which is a far more specific code to document the kind of screening you describe.

Two other factors could also be at play here. First, you must make sure that the screening appears on the mother’s record under the Mom’s name and ID, as you cannot use the 96161 and bill under the child’s name and ID. Second, if your provider also administers services to the child, such as a vaccination, during the encounter, you will need to append modifier 59 (Distinct procedural service) to the 96161 to indicate that screening was performed as a separate service at the same time your pediatrician also provided services to your newborn patient.