New Codes for Health Behavior Assessment and Intervention for 2020

Chris Breithoff, CPC, CPCO, CDEO, CRC Profee Coding Leave a Comment

New Codes for Health Behavior Assessment and Intervention for 2020

There were 6 codes deleted for 2020 and 9 new codes were added under the Health Behavior Assessment and Intervention section. These family of codes were first established in 2002. With increased awareness and need for these types of services there was a need for more code revisions. Codes 96150-96155 have been deleted and replaced with the new codes 96156, 96158, 96159, 96164, 96165, 96167, 96168, 96170 and 96171.

Health and behavior assessment and intervention services are used to identify and address the emotional, psychological, behavioral, cognitive and interpersonal factors that are essential to the assessment and/or treatment of the physical health problem(s). The term “physical health problem” is key to these family of codes. The patient’s primary diagnosis needs to be a medical condition. The patient can have a mental health condition also, but this is not the reason for these codes. These new codes are to be used for assessment and intervention to help improve and focus on factors that are complicating the medical condition(s) and the treatment of the patient’s physical illness, diagnosis or symptoms. These services do not represent preventative medicine counseling and risk factor reduction interventions. These are used to help the patient deal with their medical condition(s).

For the health behavior assessment, the provider evaluates the patient through various ways – observation, talking with the patient and formulating clinical decision making. During this session the provider is accessing the patient’s medical illness/injury, how the patient is coping and their ability to follow a treatment plan. This new code is 96156 – Health behavior assessment, or re-assessment. This code is no longer time-based. It replaced 96150 and 96151.

An example of health behavior assessment – a 34-year-old with severe chronic pain, phantom pain and his medication causes somnolence is referred for behavior assessment to determine his psychological factors and to determine if an intervention could be helpful is his overall treatment plan.

Once the patient has the assessment the next step would be the health behavior intervention (96158-96159). Per AMA CPT 2020 “Health behavior intervention include promotion of functional improvement, minimizing psychological and /or psychological barriers to recovery and management of and improved coping with the medical condition(s). These services emphasize active patient/family involvement. These interventions may be provided individually or in a group (2 or more patients) and/or the family with or without the patient.”

  • 96158 Health behavior intervention, individual face to face – initial 30 minutes
  • +96159 Health behavior intervention, individual face to face each additional 15 minutes

Example of an intervention: A 71-year-old female with heart disease, osteoarthritis and diabetes is referred for health behavior services to improve patient treatment compliance and engagement in self-management of her chronic conditions.

  • Health Behavior Group Intervention (96164-96165) These have been added to report face to face group health behavior intervention. A group consists of 2 or more patients. 96164 is reported for the initial 30 minutes and 96165 is an add on code for each additional 15 minutes.
  • Family Intervention WITH patient present (96197 and 96168) are used for face to face family health behavior intervention with the patient. 96167 is the first 30 minutes and add on code 96168 is each additional 15 minutes.
  • Family Intervention WITHOUT the patient present (96170-96171) reporting of these codes does not require the patient being present. 96170 is the first 30 minutes and 96171 is each additional 15 minutes

It is important when credentialing a qualified healthcare provider that will be providing health behavior assessment and intervention services that focus on medical diagnosis must be credentialed on the medical side and behavioral health side as well. It is up to the insurance payors to determine who can use these codes. This can vary by state as well. Read the new text very carefully in your CPT book or encoder.

Reference: AMA CPT 2020 guidelines

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