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- off 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) Primary Care Physician provides a brief intervention of 8 minutes One claim is (aggregate total of 16 minutes, submitted with Office 99420 is no longer billed, G0396 visit E&M code with is used for screening and BI) Modifier and SBIRT G0396 code, under the Primary Care Positive Annual Screens are physician’s licensed Flagged for Nurse/Aid to issue full Primary Care Physician concludes render provider health risk assessment office visit (billable E&M with- number modifier 25) and asks to go over Full Screen Results with individual Full Health Risk Assessment Positive Full Screens are flagged for (AUDIT/DAST) is administered and interpreted, time spent is recorded 8 Primary Care physician to review minutes. (Billable 99420)

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

SBIRT Coding Algorithm: Preventative Visit and/or Preventative Counseling PV codes; 99385-99387, 99393-99397, 99401-99404 Preventative Visit with Preventative Visit w/screening screening only, bill and BI 15 or more min, bill PV code & 99420 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, Option 1: Office Visit 99211-99215,99241-99245, E&M w/screening & BI, 15 99341-99345, 99347-99350 or more min, bill 99408/99409, less than 15 min bill only 99420 w/ E&M. Office visit with screening only, Option 2: Office Visit bill E&M code w/99420 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 Hand-Off Care provider, bill only E&M Visit. Provider #2 “SBIRT Champion” billing as a separate rendering provider. Screening Only, bill Screening w/BI 15 99420 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