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Screening and Brief Intervention: The 2008 CPT Codes
Blue Cross Blue Shield Association
Eric Goplerud, Ph.D.
December 11, 2007
2
What is SBI: Ask, Inform, Motivate
ASK:
On admission for new patients and at least once annually for existing patients, ask two preliminary screening questions:
When was the last time you had more than four drinks in one day? Do you use marijuana, cocaine, or other drugs? If “No” to both questions, simply continue with
necessary medical care and use the appropriate Evaluation and Management (E&M) procedure code.
If “Yes,” conduct a more in-depth screening (AUDIT and/or DAST recommended).
3
What is SBI: Inform
INFORM
Use the results of screening and any other information (GGT, BAC, etc) in the patient’s medical record to conduct a brief intervention.
A qualified health care professional presents the results of the screening to the patient, comparing the patient’s substance use to healthy standards of use (NIAAA Guidelines) and providing information about the impact that current use patterns could have on the patient’s health and well-being.
4
What is SBI: Motivate
MOTIVATE
A qualified health care professional leads a discussion that focuses on the impact of the patient’s substance use and possible ways that the patient might change behavior. Discuss ambivalence and reasons for change. Generate plans and commit to plans to change behavior. Schedule check-up on change plan or if patient is referred to a specialist for more intensive intervention. Document screening and brief intervention is entered into the patient’s record.
5
Likelihood of Positive Screen, BI and Treatment
0%
10%
20%
30%
40%
50%
PositiveScreens
BI Needed TX Needed
Ambulatory Medical Inpatient MedicalHospital Emergency Dept. Trauma CenterMental Health Ambulatory Inpatient Psychiatric
6
New Procedure Codes for SBI
HCPCS
New codes approved by CMS H0049 Screening H0050 Brief Intervention
In effect as of January 1, 2007 Wisconsin Medicaid currently pays Close in some states – NY, CA, TN, CO, RI, GA, HI
8
New codes published Nov 2 in 2008 CPT Manual 99408
Alcohol and/or substance use structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes
99409 greater than 30 minutes
Separate or added service Major commercial health plans anticipate use in 2008
2008 CPT
Common Procedure Terminology
9
2008 MedicareCMS Physician Payment Schedule
CMS Medicare codes and Relative Values published Nov. 7 in Federal Register Directs Medicare FFS to use new “G” codes
G0369 – Assessment and BI 15 to 30 minutes G0370 – 30 minutes plus
Relative Values 99408, G0396 ~$24 99409, G0379 ~$48
10
Characteristics of Screening and Brief Intervention (SBI) CPT and CMS Physician Payment Schedule signal AMA
and CMS recognition that SBI is a separate and distinct medical procedure
requires significant amount of time and additional acquired skills to deliver beyond that required for provision of general advice
SBI techniques are discrete, clearly distinguishable clinical procedures that are effective in identifying problematic alcohol or substance use.
SBI may be opportunistically delivered in general and specialty medical practice with patients who may not be seeking substance use care or meet DSM/ICD-9 diagnostic criteria of abuse or dependence
11
Clinical Vignette (99408)
A 45-year-old male is brought to the emergency department (ED) after falling down a flight of stairs and briefly losing consciousness. A comprehensive history and physical examination revealed a Colles fracture, two prior injury-related ED visits, in one of which a suspicion of alcohol involvement was documented and a history of drinking alcohol-containing beverages two to three times per week. Based upon the H&P, the physician considers the risk of an underlying alcohol problem to be significant, and elects to screen the patient. Total SBI time is 20 minutes.
12
Clinical Vignette (99409) 42-year-old female at unscheduled ambulatory visit for wheezing.
History of acid reflux, headaches, insomnia, mild hypertension, alcohol problems in two first-degree relatives. The patient recently left her job, and uses alcohol socially several times per week. DX: mild asthma exacerbation, prescribed an inhaled beta-2 agonist. The physician assessed risk of alcohol use disorder with a standard 10-item AUDIT questionnaire. Physician provides feedback about drinking and expresses medical concern, assists patient to explore ambivalence about changing drinking, helps her generate options to reduce unhealthy drinking, develops a plan and commitment to change. Total SBI time is 35 minutes.
13
Volume Estimates by Insurance Type Private
state adjuster 1.00
Annual number of outpatient claimants 400,000
Annual number of emergency department claimants 150,000
Annual number of inpatient claimants 75,000
Likely number of unhealthy drinkers in entire claimant pool (outpatient) 7.50% 26,880
Likely number of unhealthy drinkers in entire claimant pool (ED) 13.55% 18,328
Likely number of unhealthy drinkers in entire claimant pool (Inpatient) 7.40% 4,875
14
Proportion of all claimants screened (% can be adjusted for vigorous promotion of screening) 0.4
Proportion of hazardous drinkers identified in routine SBI program (outpatient) 0.8 8,602
Proportion of hazardous drinkers identified in routine SBI program (ED) 0.8 5,865
Proportion of hazardous drinkers identified in routine SBI program (inpatient) 0.75 1,463
Total number of hazardous drinkers detected if screening performed all 3 settings 15,930
15
Cost of Brief Intervention (CPT reimbursementt)
Number likely to receive intervention 0.95 15,134
Cost to health plan for screening & brief intervention -- 15-30 minutes CPT 99409 or G0369 32% $24 $116,467
Cost to health plan for screening & brief intervention -- 30 + minutes CPT 99409 or G0370 18% $48 $131,026
Total cost to health plan to reimburse for screening & brief intervention $247,493
16
Derivation of Savings Due to Brief Intervention
savings from reduced health care utilization (outpatient) $523 $4,273,904
savings from reduced health care utilization (ED) $488 $2,721,673
savings from reduced health care utilization (Inpatient) $488 $678,910
Total savings due to screening & brief intervention $7,674,486
Net Savings $7,426,993
Savings per positive screen $466
Return on Investment: savings/expenditures 31