Counseling on alcohol helps patients and is billable

A column about keeping your practice in good health

By — Posted Oct. 17, 2011.

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Since early 2011, many commercially insured patients have been able to receive alcohol counseling paid at 100% with no co-pay or deductible, and the same is expected to be true for Medicare beneficiaries as of Jan. 1, 2012.

"The exciting thing is the idea that [alcohol misuse] will be covered, and there won't be patient reluctance to come back for counseling because of co-pays and deductibles," said Ryan Kauffman, MD, a family physician with Oakhill Medical Associates in West Liberty, Ohio. "I tell patients that this is something insurance companies consider important enough that they are willing to pay for it."

Just asking about alcohol abuse will not necessarily lead to reimbursable payment, but treating those who screen positive most probably will. In addition to the usual fee-for-service, other incentives on the table should further make dealing with the issue more financially feasible for practices and make it more likely that patients will enter treatment.

"The value of it is clear, and enough companies are starting to pay for it," said Robert Gwyther, MD, professor of family medicine at the University of North Carolina at Chapel Hill School of Medicine. "Physicians need to know that this is billable and code-able. Physicians can collect for it."

The National Institute on Alcohol Abuse and Alcoholism says the first step is to ask patients about frequency, timing and amount of drinking. Much like screening for tobacco use, basic questions about drinking usually are not billable as a separate service. Most practices include questions about alcohol as part of the intake form, although documenting this in an electronic medical record may result in qualifying for a meaningful use bonus.

Tracking the percentage of adolescents and adults with new episodes of alcohol or other drug dependence who initiate treatment is on the list of eligible professional measure specifications from the Centers for Medicare & Medicaid Services.

In addition, addressing alcohol-related issues is expected to be one of the quality measures that will lead to bonuses within an accountable care organization.

Follow-up questions on attempts to stop drinking and any difficulties alcohol is causing may further elucidate the extent of the situation and help the physician decide if counseling is appropriate. Various organizations give minimums for how many drinks a day are considered a problem, but insurers don't necessarily provide such definitions.

"If the person doesn't have a problem, then you don't bill for it, but it doesn't take much time," Dr. Gwyther said. "But if you find a person has a problem, you can stop right then and there and turn it into a brief intervention for alcohol and you can bill for it."

The next step is to assess a patient's readiness to change. Patients can get information about the health risks of their behavior and the potential benefits of quitting. A patient and a physician should then agree on a goal of either cutting back or quitting.

Information should be noted in the patient's chart, along with the time spent on this task. Counseling sessions longer than 15 minutes are billable, but shorter ones are not.

"They're going to need to document time and context of the service," said Cindy Hughes, coding and compliance specialist with the American Academy of Family Physicians. "If they're using a structured screening tool, this should be included."

On July 19, CMS issued a proposed decision memo stating that, as of Jan. 1, 2012, Medicare will cover annual alcohol misuse screening. (A final decision has not yet been made.) Under the proposal, Medicare would pay for four brief, face-to-face behavioral counseling interventions a year. The American Medical Association and other medical societies support his move.

When billing, code G0396 should be used for 15 to 30 minutes of intervention of a Medicare beneficiary. G0397 is for sessions lasting longer than 30 minutes.

The ICD-9 code 303.9 can be used for patients who are alcohol dependent. Code 303.91 is for those who are dependent and drink continuously. Code 303.92 is for dependent drinkers who imbibe periodically. Code 303.93 is for those dependent on alcohol who are in remission. Code 305 can be used for those who abuse alcohol but are not necessarily addicted. Code 305.01 covers those who drink continuously, while code 305.02 is for those who abuse alcohol episodically.

In addition, alcohol misuse screening and counseling is on the list of preventive services that non-grandfathered health plans must cover at 100% with no deductible or co-pay, according to the Patient Protection and Affordable Care Act.

Grandfathered health insurance plans are those that have not changed since the health system reform law was enacted. Non-grandfathered ones are new policies issued after Sept. 23, 2010, and must cover a recommended list of preventive services with no cost-sharing with patients.

Some patients know which category their policy falls into, but others don't. This should be verified. Physicians also may need to collect co-payments and deductibles if an acute issue is dealt with during a preventive services visit.

"Certify benefits before the patient arrives," Hughes said.

When billing private insurers, the CPT codes are 99408 for an intervention lasting 15 to 30 minutes. An intervention longer than 30 minutes should be coded 99409.

H0049 is the code for alcohol and drug screening of Medicaid beneficiaries. H0050 can be used for every 15 minutes of intervention. The services can be provided by a nurse practitioner or physician assistant as well as a physician.

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