2020 Coding Updates for Health Behavior Assessment and Intervention
Health Behavior Assessment and Intervention
Health behavior assessment and intervention services are used to identify and address the psychological, behavioral, emotional, cognitive, and interpersonal factors important to the assessment, treatment, or management of physical health problems. The patient’s primary diagnosis must be physical in nature and the focus of the assessment and intervention is on factors complicating the medical conditions and treatments. These codes describe assessments and interventions to improve the patient’s health and wellbeing utilizing psychological and/or psychosocial procedures designed to ameliorate specific disease-related problems. In this article, we have discussed 2020 coding updates for health behavior assessment or re-assessment.
Health behavior assessment, or re-assessment, include evaluation of the patient’s responses to disease, illness or injury, outlook, coping strategies, motivation, and adherence to medical treatment. Assessment is no longer a time-based service. Performance of the new event-based assessment service is conducted through health-focused clinical interviews, observation and clinical decision-making and billed with CPT code 96156.
Intervention services include the promotion of functional improvement, minimization of psychological and/or psychosocial barriers to recovery, and management of and improved coping with medical conditions. These services emphasize active patient/family engagement and involvement. Intervention services may be provided to:
- An individual and is billed with CPT codes 96158, +96159;
- A group of 2 or more patients and is billed with CPT codes 96164, +96165 for each individual patient in the group;
- A family, with the patient present, and is billed with CPT codes 96167, +96168; or
- A family, or without the patient present, and is billed with CPT codes 96170, +96171.
Assessment or Re-Assessment
- CPT code 96156 is used to describe health behavior assessment, or re-assessment, that is conducted through health-focused clinical interviews, observation, and clinical decision-making.
- Assessment services are now event-based and CPT code 96156 is billed only once per day regardless of the amount of time required to complete the overall service. Only report 96156 for the assessment of a patient with a primary diagnosis that is physical in nature.
- Do not report 96156 on the same day as psychiatric services (90785-90899) or adaptive behavior services (97151-97158, 0362T, 0373T).
- For patients that require psychiatric services or adaptive behavior services, as well as health behavior assessment/intervention, report the predominant service performed.
- Evaluation and Management (E/M) services codes, including counseling risk factor reduction and behavior change intervention (99401-99412), should not be reported on the same day as health behavior assessment and intervention codes by the same provider:
- These services can occur and be reported on the same date of service as long as the E/M service (99401-99412) is performed by a physician or other qualified health care professional (QHP) who may report evaluation and management services.
- However, health behavior assessment and/or intervention services performed by a physician or other QHP who may report E/M services should do so using codes found in the E/M Services or Preventive Medicine Services sections of the CPT® Manual.
CPT © Copyright 2021 American Medical Association
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