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CPT Assistant, June 2014 - Beacon Health Options

assistant Official source for CPT coding guidance june 2014 / Volume 24 Issue 6. Page 3 Page 11 Page 12 Page 14. adaptive behavior Active Wound-Care Conventions of Frequently Assessments and Treatment Management: Low- ICD-10-CM Asked Questions Descriptors for July 1, 2014 Frequency Ultrasound Reporting 1 5/12/14 3:17 PM. CPT assistant Editorial Board* Editorial Staff Chair: Kenneth P. Brin, MD, FACC Danielle Pavloski, RHIT, CCS-P, Managing Editor Vice Chair, CPT Editorial Panel Biljana Dimovski, Editorial assistant Secretary: Danielle Pavloski, RHIT, CCS-P Contributing Author(s). Managing Editor, CPT assistant Benjamin Shain, MD, PhD, American Academy of American Medical Association Child and Adolescent Psychiatry Claudia J.

Assistant Official source for CPT coding guidance June 2014 / Volume 24 Issue 6 Page 3 Adaptive Behavior Assessments and Treatment Descriptors for July 1, 2014 Reporting

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Transcription of CPT Assistant, June 2014 - Beacon Health Options

1 assistant Official source for CPT coding guidance june 2014 / Volume 24 Issue 6. Page 3 Page 11 Page 12 Page 14. adaptive behavior Active Wound-Care Conventions of Frequently Assessments and Treatment Management: Low- ICD-10-CM Asked Questions Descriptors for July 1, 2014 Frequency Ultrasound Reporting 1 5/12/14 3:17 PM. CPT assistant Editorial Board* Editorial Staff Chair: Kenneth P. Brin, MD, FACC Danielle Pavloski, RHIT, CCS-P, Managing Editor Vice Chair, CPT Editorial Panel Biljana Dimovski, Editorial assistant Secretary: Danielle Pavloski, RHIT, CCS-P Contributing Author(s). Managing Editor, CPT assistant Benjamin Shain, MD, PhD, American Academy of American Medical Association Child and Adolescent Psychiatry Claudia J.

2 Bonnell, RN, MLS Contributing Staff Blue Cross Blue Shield Association Biljana Dimovski, CDC; Lia Levreau-Davis, CPC, Nelly Leon-Chisen, RHIA MBA; Janette Meggs, RHIA; Mary O'Heron, RHIA;. American Hospital Association Danielle Pavloski, RHIT, CCS-P; Arletrice Watkins, MHA, RHIA; Rejina Young Simon P. Cohn, MD. America's Health Insurance Plans Book and Product Development and Production Nancy Baker, Manager, Book and Product Development Carolyn A. Cunningham, MD and Production Contractor Medical Director Lisa Chin-Johnson, Senior Developmental Editor Lee H. Hilborne, MD, MPH, FASCP Mary Ann Albanese, Production Specialist Former CPT Editorial Panel Marketing Manager R. Patrick Jacob, MD, FACS, FAANS Laura Schmidt CPT Advisory Committee Charles F.

3 Koopmann Jr, MD Order Information AMA Specialty Society RVS Update Committee 1 year (12 issues). AMA members $149 Nonmembers $199. Victor L. Lewis, Jr, MD, FACS 2 years (24 issues). CPT Editorial Panel AMA members $205 Nonmembers $299. Marsha Mason-Wonsley, MA, RN Back Issues 2 Centers for Medicare & Medicaid Services AMA members $ Nonmembers $ Discount prices online at Karen O'Hara, BS, CCS-P. Phone Orders: American Medical Association Call (800) 621-8335 Fax (312) 464-4184. Daniel Picus, MD, FACR, RCC To receive the member price, please provide the member's CPT Advisory Committee number. View more AMA publications at Phillip E. Ward, DPM To change address information, please call AMA's Health Care Professionals Advisory Committee Customer Services Department at (800) 621-8335.

4 *Established February 2007. Beginning with the May 2007 Notification of change of address must be made at least six issue, all content has been reviewed by the CPT assistant weeks in advance. Editorial Board. AMA Web site address: Mailing address: AMA Acknowledgements CPT assistant James L. Madara, MD American Medical Association Executive Vice President, Chief Executive Officer AMA Plaza 330 North Wabash Avenue, Suite 39300. Bernard L. Hengesbaugh Chicago, IL 60611-5885. Chief Operating Officer CPT assistant is designed to provide accurate, up-to-date coding Mary G. Henderson, PhD information. We continue to make every reasonable effort to ensure the Senior Vice President and General Manager, AMA Business accuracy of the material presented.

5 However, this newsletter does not replace the CPT codebook; it serves only as a guide. Services 2014 American Medical Association. All rights reserved. No part of this publication may be reproduced in any form without prior Jay Ahlman written permission of the publisher. CPT is a registered trademark Vice President, Coding and Reimbursement of the American Medical Association. Products Portfolio Cover image: Alex Raths/ Thinkstock/ Getty Image Lighthouse (page 11): Thinkstock/ Getty Images AC29:14-P-024:06/14. CPT assistant june 2014 / Volume 24 Issue 6. 2 5/12/14 3:17 PM. adaptive behavior Assessments and Treatment Descriptors for July 1, 2014 Reporting Current Procedural Terminology (CPT ) Category III [96101]; development screening [96110]; neurobehavioral adaptive behavior Assessment and Treatment codes and status exam [96116]; neuropsychological testing [96118].

6 Guidelines were published on the AMA CPT Web site at Health and behavior intervention [96152]; group speech (see Related Link-Category III therapy [92508]; and occupational therapy evaluation codes) in January and March 2014 , for implementation on [97003]. These codes are outside the scope of practice for July 1, 2014 , and for inclusion in the CPT 2015 code set. most of the professionals (eg, behavior analysts) who typi- The Category III codes are a set of temporary codes that cally provide ABA services and typically, the elements of provide a uniform mechanism for reporting emerging tech- these codes are not met when ABA services are rendered. nology services and procedures and facilitate data tracking CPT Category I codes should not be used to report adap- and utilization.

7 Tive behavior assessment and treatments. However, it is not uncommon for other professionals (eg, psychologists) to use The Category III codes for adaptive behavior assessment behavior -analytic principles and procedures as components and treatment are applicable to patients of any age with of their overall clinical assessments and interventions, and autism spectrum disorders (ASDs) or other diagnoses or in such cases, CPT Category I codes may be appropriate. conditions (eg, developmental disabilities, head trauma). associated with deficient adaptive or maladaptive behaviors Occupational therapists (OT); speech language patholo- (eg, impaired social skills and communication, destructive gists (SLP); licensed clinical social workers (LCSWs).)

8 Behaviors, or additional functional limitations secondary physical therapists (PTs); psychiatrists; psychologists; and to maladaptive behaviors). These codes were developed by clinical neurologists also provide services to patients with a CPT Editorial Panel workgroup consisting of members ASD. However, their services are considered separate and representing psychiatry, psychology, speech-language and distinct from ABA and should be reported separately, as hearing, clinical social workers, neurology, occupational instructed in the exclusionary parentheticals in the new therapy, behavioral analysts, pediatrics, and payers. Category III adaptive behavior assessment and treatment 3. codes: While the adaptive behavior assessment and treatment Category III codes may be used by any physician or other (For psychiatric diagnostic evaluation, see 90791, 90792).

9 Qualified Health care professional (licensed and/or creden- tialed professional), the majority of these services will be (For speech evaluations, see 92521, 92522, 92523, 92524). delivered by a behavior analyst (advanced degree profes- sional) or licensed psychologist who designs and directs (For occupational therapy evaluation, see 97003, 97004). treatment protocols delivered by an assistant behavior analyst or technician(s). Some states require that behavior (For medical team conference, see 99366, 99367, 99368). analysts be certified by the behavior Analyst Certification Board (BACB). State laws and government and private (For Health and behavior assessment/intervention, see Health plans determine coverage for these services and who 96150, 96151, 96152, 96153, 96154, 96155).

10 May report and receive these services. (For neurobehavioral status exam, use 96116). Legislation requiring coverage of autism treatment including applied behavior analysis (ABA) services (For neuropsychological testing, use 96118). has been considered or already enacted by most, if not all, states. A uniform mechanism was not available for reporting ABA services as states and insurance companies Workgroup's Guiding Principles adopted the use of different codes. Some states adopted Level II Healthcare Common Procedure Coding System for Code Development (HCPCS) codes (eg, H2001, H2010, H2011, H2012, H2013, The CPT Editorial Panel ABA workgroup applied a list of H2014, H2019, H2020), while others allowed the use of guiding principles to their development of the assessment Level 1 HCPCS codes (CPT Category I codes) that do and treatment codes, specifically that the codes should (1).


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