Addictions & Mental Health Division Process Flow and Billing - - PowerPoint PPT Presentation

Addictions & Mental Health Division

Process Flow and Billing SBIRT Work Group Discussion

Process Flow Approaches

• Single Provider- this is when a single licensed

rendering provider performs the office/preventative visit and SBIRT services.

• Team- this is when two licensed rendering providers

partner to provide the office/preventative visit and SBIRT services.

• Warm Hand-off- this is when a licensed rendering

provider performs the office/preventative visit and hands-

• ff the SBIRT services to a secondary provider (e.g.

Health Educator, CADC), this could fall under single or team approach model.

The Single Provider Approach

Front Desk Issues and interprets “Annual Screen” (not billable) Positive Annual Screens are Flagged for Nurse/Aid to issue full health risk assessment Full Health Risk Assessment (AUDIT/DAST) is administered and interpreted, time spent is recorded 8

• minutes. (Billable 99420)

Positive Full Screens are flagged for Primary Care physician to review Primary Care Physician concludes

• ffice visit (billable E&M with-

modifier 25) and asks to go over Full Screen Results with individual Primary Care Physician provides a brief intervention of 8 minutes (aggregate total of 16 minutes, 99420 is no longer billed, G0396 is used for screening and BI) One claim is submitted with Office visit E&M code with Modifier and SBIRT G0396 code, under the Primary Care physician’s licensed render provider number

The Team Approach

Front Desk administers Annual Screen (not Billable) Front Desk interprets and flags positive risky annual screens for nurse/aid Nurse/Aid administers a full health risk assessment (AUDIT/DAST) and interprets results. Records time to administer and interpret (Billable 99420) Nurse/Aid flags positive risky full screen for licensed “SBIRT Champion” and primary care physician Primary care Physician provides office visit and informs individual that “SBIRT Champion” would like to discuss results of health risk screening (billable office visit E&M) “SBIRT Champion” enters exam room asks individual to discuss results and provides a 15 minute aggregate of administering, interpreting and providing brief intervention (billable 99408, 99420 no longer billable) Office visit is billed under the primary physician’s licensed rendering

• number. A second

claim is submitted for SBIRT services under the “SBIRT Champion’s” licensed rendering number.

SBIRT Coding Algorithm: Preventative Visit and/or Preventative Counseling

PV codes; 99385-99387, 99393-99397, 99401-99404

Preventative Visit with screening only, bill PV code & 99420 Preventative Visit w/screening and BI 15 or more min, bill PV code & 99408/99409 Preventative Visit w/screening and BI less then 15 min, bill PV code & 99420

SBIRT Coding Algorithm: Office or Home Visit

Office E&M Codes; 99201-99205, 99211-99215,99241-99245, 99341-99345, 99347-99350 Office visit with screening only, bill E&M code w/99420

Option 1: Office Visit E&M w/screening & BI, 15

• r more min, bill

99408/99409, less than 15 min bill only 99420 w/ E&M. Option 2: Office Visit E&M w/screening & BI 15 min or more, bill E&M w/modifer 25 and G0396/G0397

SBIRT Coding Algorithm: Hand-Off

Provider #1 Primary Care provider, bill only E&M Visit. Hand-Off Provider #2 “SBIRT Champion” billing as a separate rendering provider. Screening Only, bill 99420 Screening w/BI 15 min or more bill 99408/99409. Screening with BI less than 15 bill 99420

Billing Gaps/Limitations

• When screening and BI is performed and less than 15

minutes is spent, the BI is not being captured in claims data only the screening is being captured.

• First step in the SBIRT process the “annual screen” is not

being captured.

• Incentive Measure is limited to select diagnosis codes,

providers may diagnose with codes not identified in the measure, thus the service is not being captured.

• Some Providers EHR is limited and unable to suppress

billing private pay individuals and private insurance for SBIRT.

SBIRT Measure Specification Recommendations

• Expand diagnosis codes
• Explore option to add a modifier to E&M

code to identify when a BI was performed less than 15 minutes

• Explore options to capture annual screens