Wiki Is PHQ and GAD part of the testing/assessment in MDM Chart?

mc1030

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Hello all!
I have a provider asking to me to switch her code from 99214 to 99215 and after reviewing the document, it seemed to me that it met the 99214. She did prescription management and the patient had more then one chronic illnesses with her time spent total of 34 minutes. I was told that the PHQ and GAD was a standard testing that these provider do on all their visits and not considered for MDM (let me know if this isn't true).
So, I told the provider that I did not see any unique testing or assessment that met the category and that she needed at least 2 category to meet the high level. She questioned me how PHQ and GAD were not an assessment and what would be a unique testing/ assessment that is considered for Behavioral Health MDM. I tried researching some answers and checked the book but I am not getting a clear answer for it when it comes to Behavioral Health. I appreciate any advice! Thank you
 
I would agree that the prescription drug management & 2 more chronic conditions would put you at the 992X4. I also agree with you that these 2 assessments do not bump her up to a level 5; especially since its not just 2 unique tests, but 2 categories that are required (I'm not sure what other data was reviewed though).
Additionally, I was under the impression that the GAD 7 & PHQ9 along with other brief screening tools such as the ASAM & CSSR, could be billed in addition to the E/M as 96127 (up to 4 per day). Would love feedback on this as well. Thank you
 
Hello all!
I have a provider asking to me to switch her code from 99214 to 99215 and after reviewing the document, it seemed to me that it met the 99214. She did prescription management and the patient had more then one chronic illnesses with her time spent total of 34 minutes. I was told that the PHQ and GAD was a standard testing that these provider do on all their visits and not considered for MDM (let me know if this isn't true).
So, I told the provider that I did not see any unique testing or assessment that met the category and that she needed at least 2 category to meet the high level. She questioned me how PHQ and GAD were not an assessment and what would be a unique testing/ assessment that is considered for Behavioral Health MDM. I tried researching some answers and checked the book but I am not getting a clear answer for it when it comes to Behavioral Health. I appreciate any advice! Thank you
When 96127 is billed, this is reporting the provision, scoring, and documentation of the behavioral health assessment (not physician work). When the patient's scores are used by a physician or QHP in MDM, they would count toward data reviewed but only once per instrument (ie, don't count both order and review of score).

That said, it sounds your determination of a 99214 visit is likely correct. If the review and use of these scores in MDM (eg, determining the effectiveness of current treatment of the conditions assessed using the instruments) elevates the amount and/or complexity of data to be reviewed and analyzed from a moderate to high level, be very careful that you are correctly determining the data to be reviewed and analzyed at the visit. As Jltross previously noted, a high amount and/or complexity of data requires meeting the requirements of 2 of the 3 data categories. This could be possible only if the physician/QHP reviews and analyzes a combination of 3 types of data in Category 1 data and also meets the requirements for either Category 2 (independent review of tests provided by another physician or QHP [eg, imaging, ECG tracing]) or Category 3 (discussion of management or test interpretation with an external physician/QHP/appropriate source).

Two or more stable chronic conditions and/or one chronic condition with exacerbation, progression, or side effects of treatment support a moderate number and complexity of problems addressed. To support high MDM, in addition to a high amount and/or complexity of data, documentation must support either a severe exacerbation, progression, or side effects of treatment or high risk of morbidity from additional diagnostic testing or treatment.

I hope that is helpful.
Cindy
 
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