How to Bill for New 2019 CPT G2011 and G0396

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READER’S QUESTION:

How to Bill for New 2019 CPT G2011 and G0396

Hello! We were told that the G2011 and G0396 can now be used if we are counselling patients about addiction.. Is this correct that we can use it as a pain office and what diagnosis code would you recommend? Thanks for your time, your information is so helpful.

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G2011 is a new HCPCS code for 2019. It’s code descriptor is Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention, 5-14 minutes
Use this code for Medicare patients and other payers who recognize and accept this code

G0396 Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes

G0397 Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes

For Non-Medicare patients such as your Commercial Payers that does not recognize your G codes; you can use a cross-over CPT code shown below:

99408 Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes
99409 Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; greater than 30 minutes

How does G0396 and G0397, CPT Code 99408 and 99409 rendered by the Provider?
The provider uses a validated screening instrument to screen the patient. Validated means the test has been proven for reliable consistency of results, validity, sensitivity in identifying patients with conditions, and specificity in identifying patients who don’t have a condition. Examples of validated screening instruments include the alcohol use disorder identification test, or AUDIT, and the drug abuse screening test, or DAST. The provider records the screening instrument used.

Based on the screening score, the provider performs a brief intervention, documenting the nature of that intervention. For instance, the provider may discuss the negative health and social consequences of continuing the substance abuse, talk to the patient about how much and how often the substance abuse occurs, discuss with the patient steps for changing behavior, and create plans for taking those next steps. The provider spends 15 to 30 minutes on the screening and intervention.

These services must be based on Medical Necessity. In terms of diagnosis, I suggest you report the reason of the assessment, include result, condition and symptoms of the patient.

Here’s a good reading reference from Medicare website – https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/SBIRT_Factsheet_ICN904084.pdf

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