Behavioral Health: To Screen or not To Screen?

How to stay compliant in behavioral health screenings.

Behavioral health screenings aim to detect mental health symptoms in many seemingly healthy people. This can be done in various ways, including using paper-based instruments in the exam room, computer-based screening in the waiting area, and physician interviews during routine exams. The goal is to apply these screening methods uniformly to patients with potentially undiagnosed mental health problems. Screening and assessment services should be reported when indicated unless a payer’s written policy restricts doing so.

Specific screening and assessment codes are selected based on the provider types performing them, time, or modality.

1. physicians (MD/DO)
   
2. non-physician practitioners (NPP):
   • Clinical psychologists (CP), clinical social workers (CSW), clinical nurse specialists (CNS), nurse practitioners (NP), physician assistants (PA), certified nurse-midwife (CNM), and independently practicing psychologists (IPP).
     
3. ancillary staff:
   • Technicians, medical assistants, and nurses

For example, CPT® code 96127, Brief emotional/behavioral evaluation (e.g., depression inventory, attention-deficit/hyperactivity disorder scale), with scoring and documentation, following standardized instrument) is the code to use when indications or symptoms prompt a provider to supply a patient with a brief emotional/behavioral assessment. The standard screening tool is the Patient Health Questionnaire-9 (PHQ-9). This service can be performed by physicians, NPPs, or ancillary staff.

CPT® defines “standardized” as “previously validated tests that are administered and scored in a consistent or ‘standard’ manner.” “Scoring” distinguishes between an actual health risk assessment and history gathering forms. At the very least, the instrument must offer a threshold result or relevant “yes/no” responses that indicate a patient’s risk of an adverse health outcome or further worsening of an existing, usually chronic, medical condition.

Payer guidance varies from payer to payer, especially reporting depression screenings. For example, some payers recommend postpartum depression screenings should be reported with code 96127 while others recommend reporting codes 96160 or 96161. There is much misunderstanding about these codes, and double-check payers’ policies. Most commercial payers may process their behavioral health claims separately by utilizing a third-party payer. The claim should be processed by the physical medicine side if the mental health tests were utilized to assess whether or not the patient’s mental health was influencing his or her physical health. Physical medicine ICD-10-CM codes rather than mental health diagnosis codes may help avoid the difficulties that come with behavioral health coverage.

Another payer difference, Medicare refers to specific Healthcare Common Procedure Coding System (HCPCS) code G0444 for Medicare patients who are undergoing a depression screening without symptoms (i.e., as a preventative treatment). Code G0444 may be reported for an annual depression screening lasting up to 15 minutes using any standardized instrument (e.g., PHQ-9) in a primary care setting with clinical staff who can facilitate and coordinate referrals to mental health treatment as needed. Depression screening should not be separately reported when provided as part of the initial preventive physical examination (“Welcome to Medicare” physical) or initial annual wellness visit.

Alternatively, screening, Testing is used to evaluate the existence or absence of a mental health disorder when the possibility of one has been proven by screening or the presence of a comorbid illness. Test administration needs “medical necessity” for billing purposes, which must be supported by an ICD-10-CM code. A physician or qualified healthcare professional, or a technician under the supervision of a physician or qualified healthcare professional, can administer the test using the technique approved for each code.

Test assessment services are intended to cover the time spent by a physician or other qualified healthcare professional assessing the findings of a patient’s mental health tests and formulating a treatment plan. Furthermore, some short assessment instruments, such as the Epworth Sleepiness Scale, may be classified as a health risk assessment (HRA) by some payers but combined with a diagnostic evaluation and treatment service by others.

Many screenings and assessments are recommended during preventive services, and some may be considered in performance measures and incentive payments. Although payments for screening and assessments are minimal, they can build up to a substantial amount of revenue throughout a patient-specific course of care.

Some of the codes used are: