Primary Care Coding Alert

Question: Our provider received results of a Drug Abuse Screening Test (DAST-10) and an Alcohol Use Disorders Identification Test (AUDIT) from our patient’s school. The provider also administered a Patient Health Questionnaire (PHQ-9) and a Generalized Anxiety Disorder Test (GAD-7). Can we bill for the tests we did not administer, even though our provider interpreted the results, and if we can, do we bill 96127 x 4 or 96127 as separate units?

Codify Subscriber

Answer: Both tests your provider administered are appropriately documented with 96127 (Brief emotional/behavioral assessment (eg, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument). As the descriptor states, the service involves briefly testing for behavioral and emotional conditions such as anxiety and depression.

The procedure’s descriptor also indicates that the service includes both scoring and documentation of the test as well as its administration. Simply put, if someone other than the provider, such as a teacher or the patient’s parent or guardian, administered the test, you cannot report it. Thus, you should not bill for the DAST-10 and AUDIT received from the patient’s school.

As for how to document the individual tests, you will need to check with your payer about how it prefers them to be reported. The payer may be fine with you reporting separate units of 96127, or it could ask you to report two units of 96127 with modifier 59 (Distinct procedural service) appended to the second unit. As noted, the descriptor includes the phrase “per standardized instrument,” so you may report the code multiple times, as necessary, to represent the administration of multiple different instruments for an individual patient encounter.