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CPT code changes for health risk assessments take effect Jan. 1

November 4, 2016

Editor’s note:This is the second of two articles on Current Procedural Terminology (CPT) code changes for 2017. The first article is available at www.aappublications.org/news/2016/10/05/Coding100516.

As reported in the October column, there will be new codes on Jan. 1 for reporting administration and scoring of a patient-centered health risk assessment and a caregiver-focused health risk assessment. Following is additional information on the new health risk assessment codes.

Code 96161 will be reported for use of a standardized instrument to screen for health risks in the caregiver for the benefit of the patient. It is intended that code 96161 will be reported to the patient’s health plan as it is a service for the benefit of the patient.

Code 99420 (administration and interpretation of health risk assessment instrument, e.g., health hazard appraisal) will be deleted and replaced with code 96160 for administration of a health risk assessment for the benefit of the person completing the assessment.

It also will be important to discern what CPT code is appropriately reported for the specific screen or assessment you are performing. Listed below are the codes in the 2017 CPT manual that describe the different services. In addition, several screens/assessments are listed in the table with their corresponding CPT codes. These screens/assessments are listed for coding purposes only.

96110 Developmental screening (eg, developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument

96127 Brief emotional/behavioral assessment (eg, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument

( Indicates new code)

96160 Administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument

96161 Administration of caregiver-focused health risk assessment instrument (eg, depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument

Instrument 

96110

96127

96160

96161

Acute Concussion Evaluation (ACE) 

 

 

X

 

Ages and Stages Questionnaire – Third Edition 

X

     

Ages and Stages Questionnaire – Social Emotional

 

X

   

Australian Scale for Asperger Syndrome (ASAS)

 

X

   

Beck Youth Inventory – Second Edition BYI-II

 

X

   

Behavior Assessment Scale for Children – 2nd Edition

 

X

   

Behavior Rating Inventory of Executive Function 

 

     X

   

Conners Rating Scale 

 

X

   

CRAFFT Screening Interview 

   

X

 

Edinburgh Postnatal Depression Scale* (EPDS)

     

X

Edinburgh Postnatal Depression Scale (EPDS)

 

     X

 

 

Kutcher Adolescent Depression Scale (KADS)

 

X

   

Modified Checklist for Autism in Toddlers (MCHAT)

X

     

Patient Health Questionnaire (PHQ-2 or PHQ-9)

 

X

   

Parents’ Evaluation of Developmental Status (PEDS)

X

     

Pediatric Symptom Checklist (PSC) 

 

X

   

Screen for Child Anxiety Related Disorders (SCARED)

 

X

   

Vanderbilt rating scales

 

X

   

*When billed under the baby and not the mom

Becky Dolan, in the AAP Division of Health Care Finance, contributed to this article.

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