Primary Care Coding Alert

Tip: Double check before reporting G0396, G0397 with E/M services.

You're probably accustomed to looking through the Correct Coding Initiative (CCI) edit changes each quarter, because staying updated on new code pairs can mean the difference between claim acceptance and denial. If you haven't yet read through the 2012 CCI coding guidelines, check out two important updates on how to report unclassified drugs and certain screenings/assessments, thanks to Kristi Stumpf, MCS-P, CPC, COSC, ACS-OR, owner of Precision Auditing and Coding.

Assign 1 Unit to J3490

Most medications your family physician administers can be found in HCPCS. You might have times, however, when a specific code doesn't apply and you must resort to J3490 (Unclassified drugs) as your catch-all medication code.

Take note: When you report J3490, only submit one unit of service, no matter how much medication your physician administered. Document details about the drug and total dosage in the "Remarks" field of the claim form.

Check When G0396, G0397 Are Legit with E/M

HCPCS and CPT® 2012 both include codes for substance abuse assessments or screenings. CCI guidelines give new information for reporting the two HCPCS codes:

• G0396 " Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST), and brief intervention 15 to 30 minutes
• G0397 " Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST), and intervention, greater than 30 minutes.

Specifically, chapter 12 of National Correct Coding Initiative Policy Manual for Medicare Services (available online at http://www.cms.gov/NationalCorrectCodiNitEd/01_overview.asp) states that codes G0396 and G0397 "should not be reported separately with an evaluation and management (E&M), psychiatric diagnostic, or psychotherapy service code for the same work/time," points out Kent J. Moore, manager of healthcare delivery and financing systems for the American Academy of Family Physicians (AAFP) in Leawood, Kan.

If the E/M or other service would normally include an alcohol or substance abuse assessment and/or intervention based on the patient's clinical presentation, do not report G0396 or G0397 in addition to the E/M or other service code.

"If a physician reports either of these G codes with an E&M, psychiatric diagnostic, or psychotherapy code utilizing an NCCI-associated modifier, the physician is certifying that the G code service is a distinct and separate service performed during a separate time period (not necessarily a separate patient encounter) ... and is a service that is not included in the E/M ..." the guidelines continue.

Difference: At first glance, CPT® codes 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) seem to overlap with G0396 and G0397. Codes 99408 and 99409, however, represent screening services that Medicare doesn't cover.

Tip: Some state Medicaid programs cover 99408 and 99409. If your state does, the CCI guideline policies for G0396 and G0397 also apply to 99408 and 99409.