Wiki Billing 99408

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missykirshner

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Local Chapter Officer
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Commerce Township, Michigan
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If my provider wants to bill the 99408 code for alcohol and/or substance use screening, 2 questions:

1. Does the 15-30 minutes include the time spent in the exam or is this an additional 15-30 minutes on top of the exam spent doing the screening?

2. Since this is a screening code along with brief intervention, if he has a screening tool (questionnaire, computer based program), can the time the patient spends completing the screening count toward the 15-30 minutes?

Thanks in advance.
 
Time spent performing the evaluation and management service cannot be counted toward the 15 minute minimum for 99408 and vise versa (eg. you cannot bill a 99214 based on time alone because the provider did a 25 minute intervention). For positive screenings, but less than 15 minutes of intervention services we bill for 99420.

You cannot bill for a negative SBIRT (AUDIT/DAST) on adults because there is no intervention when the results are negative. You could bill 99420 for a negative screen; we do not because we are an FQHC. It is sometimes possible to bill for an intervention on a negative screen for adolescents, but you would want to consult your state regulations (ok in Oregon for ages 12-20).

Typically the patient answers the screening when the provider is not in the room so the time that the patient spends answering the questions would not count toward the 15 minutes. If the use of an interpreter is required, the extra time is not billable. If the provider needs to read the questions to the patient and discusses the questions with the patient, I would count that time toward the 15 minutes if it results in a positive screening that requires intervention.

One question you may want to ask your provider, does he/she really want to bill the patient for answering the two questions? This comes up often in our clinics because we treat a high volume of uninsured and underinsured patients. Keep in mind that if it is something you decide to bill insurance for, you also need to bill the patients if they are uninsured or insurance applies to deductible.

Jonique Dietzen, CPC
 
99408

Hello
I also work for HQFC providers and they are interested in using these codes. Your insight was very helpful to me and I feel the same way you do. If the screening was negative for alcohol/drug there should be no charge. The only positive outcome from the screening is the tobacco use and the code clearly states "other than tobacco". I am asking my providers to document for a tobacco cessation counseling and that can be coded, but not the SBIRT code as it was negative. For some reason they are having a hard time following my rationale. Can you tell me where you found the information you provided so I bring it to their attention. Hopefully that will help them understand what I mean. :)

I would also love to network with you as I am new to the behavioral health part of coding. I am coming from an orthopedic office.
Thank you,

Rodaika Jarvis
 
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