CPT 2020 Changes to Psychiatry Services
This auditing and compliance “Tip of the Week” was originally published by the National Alliance for Medical Auditing Specialists (NAMAS), a division of DoctorsManagement.
As of January 1, 2020, CPT made changes to the health and behavior assessment and intervention codes (96150-96155) and therapeutic interventions that focus on cognitive function (97127). If you code and audit services in this category, you must pay close attention to the changes as they include the removal and addition of time-based requirements.
For 2020, CPT added new codes for billing of health behavior intervention services. There is one new code (96156) to report health behavior assessment (HBA) or reassessment and eight new codes (96158, +96159, 96164, +96165, 96167, +96168, 96170 and +96171), four primary and four add-on codes to report health behavior intervention services. The 2020 changes deleted the codes 96150, 96151, 96152, 96153, 96154, and 96155.
As of this writing in 2019, the assessment codes (96150-96151) are time-based and used to describe services that are intended to assess factors that may affect the recovery or progression of a diagnosed physical health problem or illness. As of 2020, the new assessment code (96156) continues the understanding of the assessment service being an evaluation or reevaluation for the purpose of measuring the patient response(s) to disease or injury, but the new code will no longer be time-based. The assessment includes a health-focused clinical interview, behavioral observations, and clinical decision making. Per CPT guidelines, the focus of the assessment is not on mental health, but on the biopsychosocial factors important to physical health problems and treatments.
The new 2020 intervention service codes (96158-96171) focus on the improvement and management of medical conditions, minimization of psychological and psychosocial impediments to recovery, and improvement of medical conditions. The codes options include intervention with the participation of the patient alone, the patient in a group or families with or without the patient. Per CPT guidelines, the focus of the intervention is to improve the patient’s health and well-being utilizing cognitive, behavioral, social, and/or psychophysiological procedures designed to ameliorate specific disease-related problems.
On January 1, 2020 CPT will implement changes to the therapeutic interventions that focus on cognitive function and added 97129 and +97130 to replace deleted code 97127 for therapeutic interventions focusing on cognitive (intellectual) function and strategies to manage activities face-to-face with a patient. The two new codes place time limits on the service that were not included with the deleted code; 97129 is for the first 15 minutes, and +97130 is for each additional 15 minutes.
This Week’s Audit Tip Written By:
Stephanie is a Senior Compliance Consultant with our parent organization, DoctorsManagement
Here’s why thousands of providers trust DoctorsManagement to help improve their coding and documentation.
Quality of coders and auditors. Our US-based auditors receive ongoing training and support from our education division, NAMAS (National Alliance of Medical Auditing Specialists). All team members possess over 15 years of experience and hold both the Certified Professional Coder (CPC®) as well as the Certified Professional Medical Auditor (CPMA®) credential.
Proprietary risk-assessment technology – our auditing team uses ComplianceRiskAnalyzer(CRA)®, a sophisticated analytics solution that assesses critical risk areas. It enables our auditors to precisely select encounters that pose the greatest risk of triggering an audit so that they can be reviewed and the risk can be mitigated.
Synergy – DoctorsManagement is a full-service healthcare consultancy firm. The many departments within our firm work together to help clients rise above the complexities faced by today’s healthcare professionals. As a result, you receive quality solutions from a team of individuals who are current on every aspect of the business of medicine.