H&B Group Codes Billing Question
I have a billing question from one of our TA clients which is stumping me. Anyone have thoughts/ experience billing for groups and H&B codes?
Here is the question:
"We are wanting to use the 96153 group code providing health education and psychological interventions to our clients. Do you know if each individual group member would have to have a 96150 (Initial assessment) done before joining a group?
*** in specific- we have a 9 week program for pregnant Somali women. The program starts out with 5-10 minute 1:1 medical information given by a care coordinator, then an ongoing yoga group happens during which the nurse practitioner will pull participants for an individual check up. When all the check ups are done, they all come together for a 1 hour group on various topics. We want behavioral health to be able to bill for a few of these groups. Specifically the groups around post partum depression; stress management; and nutrition/ exercise.”
I’m not aware of any rule that states a 96150 has to be completed before a 96153 (or a 96152 for that matter). I may be completely off on this, but we’ve been billing 96152 in the absence of a 96150 at several of our integrated clinics for a year now with no denial issues that I’m aware of.
With that said, I’m open to other peoples’ thoughts on this.
GREAT question…. I have also used a 96152 without a 96150 , and I don’t think we’ve had any issues that I’m aware of… but I’ve only done it a couple of times.
And I have another for both of you….Does your group visit note (is this a DIGMA model?) look similar to your individual note?
Inquiring minds want to know!! Thank you!!!!!!!!!
Hello, I agree, it’s a great question and I can’t quickly find any regulations that address this. But, I wonder if there is still some value to doing some assessment prior to treatment with a group. The H&B assessment is pretty focused and can be done in 15 minute increments – so it can be done fairly quickly and usefully.
Also, I would want to make sure the other H&B rules are being followed regarding the need to have a medical diagnosis, etc.
I’ll be interested in what others have experienced.
Thanks, Mary Jean
Since the H&B codes rely on a medical diagnosis, I think that the original visit with the medical provider to make said diagnosis is sufficient to engage in treatment using H&B codes without 96150 being the first claim submitted – especially for group intervention. That said, a treatment plan should reflects goals appropriate to the diagnosis and group format and a quick 96510 assessment provides additional information to the clinician as well as the opportunity to set individual goal for group intervention.
Just thinking from the payer side and what we might look at in the event of an audit.
I agree with my colleagues. If using a medical diagnosis it means the patient was diagnosed by someone else, and your Intervention is to address that health related problem. Therefore I do not see the need For seperate diagnostic charge.
A helpful general resource on H&B codes: http://www.ibhpartners.org/get-started/procedures/billing-reimbursement-and-financing/