SUBSTANCE ABUSE ENCOUNTER REPORTING: HCPCS and Revenue Codes Overview of Updates for Fiscal Year 2008

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1 SUBSTANCE ABUSE ENCOUNTER REPORTING: HCPCS and Overview of Updates for Fiscal Year 2008 This encounter code and modifier chart, effective 10/1/2007, describes how submitted encounter codes and modifiers will be interpreted by MDCH and its actuarial team. Much of this remains the same as it was for FY2007. A summary of the changes and additions for FY2008 follows: A list of 11 modifiers is included on the last page of the coding chart. These modifiers can be used in combination with any of the HCPCS codes. HD is required for all qualified Women s Specialty Services. HH is required for qualifying Integrated Substance Abuse/Mental Health Services. The AMS initial screening functions will be reported with an H0002 code only if done face-toface. Otherwise, the newly available code of H0049 (Screening for Appropriateness for Treatment) can be utilized for either in-person or over-the-phone screens. Coding options for Sub-acute Detoxification Services have expanded from one allowable code to three separate codes based on ASAM level: H0010 (Medically Monitored III.7-D); H0012 (Clinically Managed III.2-D); and H0014 (Ambulatory without Extended Monitoring II.D.). The HCPCS Code of H0022 will now designate Early Intervention Services. The HCPCS Code of T1012 will now designate Recovery Support Services. Residential Room and Board will be reported under the S9976 per diem code. A selection of non-emergency Transportation HCPCS codes (T2001 through T2005, S0215, A0100, A0110) have been added to the chart. The T1009 code for Child Sitting Services has been added to the chart to allow CAs to report child care service encounter under qualified Women s Specialty Services. FY2008 Page 1 of 5 ( )

2 Service Description Screening (Initial Administrative Function) SUBSTANCE ABUSE ENCOUNTER REPORTING HCPCS and Code Description H0049, H0002 N/A H0049- AMS Alcohol and/or drug screening for appropriateness for treatment. H0002- Face-to-face behavioral health screening to determine eligibility for admission to treatment program. Assessment H0001 N/A H0001- Individual face-to-face alcohol and/or drug assessment at the licensed provider level for the pupose of identifying functional and treatment needs and to formulate the basis for the Individualized Treatment Plan. Intensive Outpatient H H0015- Alcohol and/or drug services; intensive outpatient (from 9 to 19 hours of structured programming per week based on an individualized treatment plan), including assessment, counseling, crisis intervention, and activity therapies or education Intensive Outpatient Services Chemical Dependency. Encounter (1 hour minimum) Day Series/ Outpatient H0004, , H2035, H , 0914, 0915, 0916, 0919 H0004- Behavioral health counseling and therapy, per 15 minutes , Psychotherapy (individual). H2035- An hour of outpatient alcohol/other drug treatment services. H2036- Per diem outpatient alcohol/other drug treatment services. Refer to code Series/ H0005, 90847, 90853, 90857, H2035, H , 0914, 0915, 0916, 0919 H0005- Alcohol and/or drug services; group counseling by a clinician. Family or group therapy 90847, Psychotherapy (group). H2035- An hour of outpatient alcohol/other drug treatment services. H2036- Per diem outpatient alcohol/other drug treatment services. Refer to code Series/ Pharmacologic Support Methadone H0020 N/A H0020- Alcohol and/or drug services; Methadone administration and/or service (provision of the drug by a licensed program). FY2008 Page 2 of 5 ( )

3 SUBSTANCE ABUSE ENCOUNTER REPORTING HCPCS and Service Description Code Description Subacute Detoxification H0010, H0012, H H0010- Alcohol and/or drug services; subacute detoxification; medically monitored residential detox (ASAM Level III.7-D). H0012- Alcohol and/or drug services; subacute detoxification; clinically managed residential detox; non-medical or social detox setting (ASAM Level III.2-D). H Alcohol and/or drug services; ambulatory detoxification without extended onsite monitoring (ASAM Level I.D) Residential treatment chemical dependency. Day (refer to code ) Series Residential Treatment H0018, H H0018- Alcohol and/or drug services; short-term residential (non-hospital residential treatment program). H0019- Alcohol and/or drug services; long-term residential (non-medical, non-acute care in residential treatment program where stay is typically longer than 30 days) Residential treatment chemical dependency. Day Series Early Intervention H0022 N/A H Alcohol and/or drug services; Intervention Service (Early Intervention). Any planned intervention hthat may assist a person to abstain for AOD use. Recovery Support Services T1012 N/A T Alcohol and/or drug services; Recovery Support and Skills Development. Activites to develop client community integration and recovery support. FY2008 Page 3 of 5 ( )

4 Service Description Residential Room and Board SUBSTANCE ABUSE ENCOUNTER REPORTING HCPCS and Additional For Code Description S9976 N/A S Lodging, per diem, not otherwise specified. Day Series Encounter other payers) Case Management H0006 N/A H0006- services provided to link clients to other essential medical, educational, social and/or other services. Laboratory Tests H0003, H0048, 80100, N/A H Laboratory analysis of specimens to detect presence of alcohol or drugs. H Alcohol and drug testing, collection and handling only, specimens other than blood Drug Screen. Transportation T T2005, S0215, A0100, A0110 N/A Non-emergency transportation services. Refer to code Psychiatric Evaluation 90801, N/A Diagnostic interview examination Diagnostic interview examination using play equipment, physical devices, language interpreter or other mechanisms of communication. Child Sitting Services T1009 N/A T Care of the children of the individual receiving alcohol and/or substance abuse services. Pharmacologic Support Buprenorphine or Suboxone H0033 N/A H0033 -Oral medication administration, direct observation. (Use for Buprenorphine or Suboxone administration and/or service - provision of the drug). Accupuncture N/A Accupuncture, 1 or more needles, initial 15 minutes Accupuncture, 1 or more needles, each additional 15 minutes. Physician Evaluation N/A Physician Evaluation/Exam (30 mins face-to-face) Physician Evaluation/Exam (45 mins face-to-face) Physician Evaluation/Exam (60 mins face-to-face). Medication Review N/A Review of current mdications. Encounter (faceto-face) FY2008 Page 4 of 5 ( )

5 SUBSTANCE ABUSE ENCOUNTER REPORTING HCPCS and Modifiers for Substance Abuse HCPCS Modifier Description HA Child- Adolescent Program (services designed for persons under the age of 18). HB Adult Program- Non-Geriatric (services designed for persons age 18-64). HC Geriatric Program (services designed for adults age 65 and older). HD Women's Specialty Services Pregnant/Parenting Women Program: (services provided in a program that treats pregnant women or women with dependent children). HG Opioid Addiction Treatment Program (program specifically designed to provide opioid-treatment services (including but not limited to the provision of methadone). HH HJ Integrated Mental Health/Substance Abuse Program (program specifically designed to provide integrated services to persons who need both mental health and substance abuse services, as planned in an integrated, individualized treatment plan. Employee Assistance Program (designates a service associated with and EAP. HQ Group Setting (services provided to more than one client in a single treatment event, such that the clients have no particular relationship). HR HS H9 Family/Couple with Client Present (services provided to more than one client in a single treatment event, such that persons served share familial or significant other relationships). Family/Couple without Client Present (services provided to multiple persons in a single treatment event in which some of the persons served share familial or significant other relationships, without the client present). Court-ordered (indicates that services were ordered by a court, probation officer and/or parole officer). FY2008 Page 5 of 5 ( )