Pediatric Coding Alert

Question: I’m having difficulty choosing between 96127 and 96160. My provider suspects a neurodevelopmental disorder, and therefore tested the patient’s memory, problem-solving abilities, and a series of other cognitive functions using the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2). The two codes seem very similar. Which code do I use?

Arizona Subscriber

Answer: If the provider used an attention-deficit/hyperactivity disorder (ADHD) scale, a BOT-2, or other standardized instrument, then the situation you described requires code 96127 (Brief emotional/behavioral assessment (eg, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument). Let’s break it down to understand why.

You’ll want to use 96127 whenever the provider assesses psychological and neuropsychological elements, such as memory, language, abstract reasoning, and visual motor responses. You’ll want to use 96160 (Administration of patient-focused health risk assessment instrument [eg, health hazard appraisal] with scoring and documentation, per standardized instrument), which is a health risk assessment (HRA) code, to assess how a psychological condition is affecting a patient’s physical condition. In other words, 96127 directly refers to the assessment of a mental health condition, while 96160 assesses how a mental health condition is affecting, or can potentially affect, a patient’s physical health. For example, conditions such as depression and anxiety can lead to eating disorders, drug and alcohol abuse, and a variety of other problems that have the potential to have significant physical consequences. That’s where HRA tests, reported with 96160, are appropriate.

Per the definitions, both codes require the use of standardized instruments which, according to CPT^®, “are validated tests that are administered and scored in a consistent or ‘standard’ manner consistent with their validation.” For 96127, that would include tests such as BOT-2; and for 96160, that would include tests such as Home, Education, Eating, Activities, Drugs and Alcohol, Suicide and Depression Sexuality and Safety (HEEADSSS).