Editor’s Note: Cutting through the red tape to make certain that you get paid for every dollar you earn has become more difficult than ever, particularly in our current climate of health care reform and ICD-10 transition. The ACEP Coding and Nomenclature Committee has partnered with ACEP Now to provide you with practical, impactful tips to help you navigate through this coding and reimbursement maze.
Question: Can you bill for alcohol and drug counseling the same way you do for smoking cessation?
Answer: Yes, you can. There must be some clear medical necessity documented in the chart as to why the patient is receiving these services. The requirements for 99408 (15 to 30 minutes of alcohol and/or substance abuse structured screening and brief intervention services, 0.94 relative value units [RVUs]) and 99409 (greater than 30 minutes, 1.89 RVUs) are different and more rigorous than those for tobacco cessation counseling, 99406 (0.35 RVUs) and 99407 (0.73 RVUs). First, for alcohol and/or substance abuse intervention, you must spend and document at least 15 minutes as opposed to more than three minutes for tobacco cessation. Next, you must administer a structured screening tool, such as the Alcohol Use Disorders Identification Test (AUDIT) or the Drug Abuse Screening Test (DAST).
These services may be billed on the same day as other evaluation and management (E/M) services, but they must be distinct from those E/M services and billed with a 25 modifier. However, many payers will not pay for these codes when billed on the same day as an emergency department visit. Lastly, some payers prefer to use codes G0396 (15–30 minutes) and G0397 (greater than 30 minutes), while others prefer H0050 (per 15 minutes).
Brought to you by the ACEP Coding and Nomenclature Committee.
Dr. Lempert is chief medical officer, coding policy, at TeamHealth, based in Knoxville, Tennessee.