Wiki Professional component for 96127

[angie.santana]

We have providers reporting 96127 in an Article 28 setting, however our claims are being denied as this code is a technical only code. Does anyone know where we can find documentation that explains how to bill the professional component?

 

[SharonCollachi]

96127 is a brief behavioral assessment. If you are a facility, perhaps you have it backwards... are they saying that you cannot bill it from a facility but only from a provider?

 

[Cynthia Hughes]

We have providers reporting 96127 in an Article 28 setting, however our claims are being denied as this code is a technical only code. Does anyone know where we can find documentation that explains how to bill the professional component?

Code 96127 has no physician work value. This code represents the practice expense of obtaining a structured assessment, scoring, and documentation of the instrument used and score. The physician's interpretation of the score in light of the patient presentation is part of an evaluation and management service.

I am not familiar with billing in Article 28 settings but hope this helps.
Cindy

 

[angie.santana]

Code 96127 has no physician work value. This code represents the practice expense of obtaining a structured assessment, scoring, and documentation of the instrument used and score. The physician's interpretation of the score in light of the patient presentation is part of an evaluation and management service.

I am not familiar with billing in Article 28 settings but hope this helps.
Cindy

Thank you so much Cindy. This is very helpful. Do you happen to have documentation of this that I can use to educate my provider with?

Thank you,
Angela

 

[Cynthia Hughes]

Thank you so much Cindy. This is very helpful. Do you happen to have documentation of this that I can use to educate my provider with?

Thank you,
Angela

If you look at the Medicare Physician Fee Schedule, the work RVUs are zero and the PC/TC indicator in column N is 3.
3 = Technical component only codes. This indicator identifies stand alone codes that describe the technical
component (such as staff and equipment costs) of selected diagnostic tests for which there is an associated
code that describes the professional component of the diagnostic tests only. An example of a technical
component code is 93005, Electrocardiogram, tracing only, without interpretation and report. It also identifies
codes that are covered only as diagnostic tests and therefore do not have a related professional code.
Modifiers -26 and TC cannot be used with these codes. The total RVUs for technical component only codes
include values for practice expense and malpractice expense only.

 

[SharonCollachi]

I think you're overthinking this whole thing. 96127 is for brief, self-scoring assessments completed by the patient. I called this a "trained monkey test" versus a "licensed clinician test". What I mean by that is, any trained monkey can score the test. You just add up the columns, there is no decision-making, no interpretation, nothing like that. Think of a urine pregnancy test which is a stick - there's a line, it's positive; no line, it's negative. Examples of 96127 are the Beck Depression Inventory, the PHQ.

A licensed clinician (or non-monkey test) is something like a pap smear, where someone is looking thru a microscope, identifying and counting abnormal cells, or an xray or other imaging where they are interpreting what they see.