Health Information Management

Tip: Differentiate between HCPCS, CPT codes for structured abuse and brief intervention services

APCs Insider, November 12, 2010

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Structured abuse and brief intervention services is an early intervention approach that targets those with non-dependent substance use to provide effective strategies for intervention prior to the need for more extensive or specialized treatment.

The four appropriate codes—HCPCS codes G0396 and G0397 and CPT codes 99408 and 99409—require very specific documentation.  In the outpatient setting, to determine which circumstances require which codes for SBIRT, first look at the codes’ definitions to see how they differ. The two HCPCS codes appropriate for SBIRT are fairly new, added to the Medicare Physician Fee Schedule in 2008.

The HCPCS codes use the word “assessment” in their definitions, while the CPT codes use “screening”. That means the HCPCS codes are more evaluation, while the CPT codes are more specific testing. 

Who performs the services and the medical necessity that prompted the service also determine which code is appropriate. Use the CPT codes when a physician conducts the assessment and intervention, and the HCPCS codes when nonphysician practitioners, such as nurse practitioners and clinical social workers, carry out the services.

This tip was adapted from “Look for medical necessity, signs and symptoms, and time units when coding abuse and brief intervention services” in the November issue of Briefings on APCs.



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