SBIRT - Coding for SBI Reimbursement

Most doctors and nurses don't know this, but reimbursement for screening and brief intervention is available through commercial insurance CPT codes, Medicare G codes, and Medicaid HCPCS codes.

The Substance Abuse & Mental Health Services Administration or SAMHSA is working with the Centers for Medicare and Medicaid Services (CMS) to educate practitioners about the importance of SBIRT coverage and the Medicare billing rules around these services.

SBIRT services are defined as alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., AUDIT, DAST) and brief intervention.

Commercial Insurance billing codes are CPT 99408 and CPT 99409.
Medicare codes are G0396 and G0397
Medicaid codes are H0049 and H0050

You can learn more about SBIRT coverage here and you can also purchase a novel nursing continuing education activity titled the "SBIRT Substance Use NursingMentor" here: cmecorner.com/sbirt

CPT Billing Codes reimburse for Care Coordination (Medicare)

Let's face it: physicians spend a lot of time coordinating care for their older adult patients, especially when patients leave hospitals or nursing homes. These "transitions of care" are becoming increasingly important opportunities for primary care providers to check medication reconciliation, prevent readmission, and facilitate appropriate follow-up.

Medicare is now accepting newly created Current Procedural Terminology (CPT) codes for care coordination to pay physicians for the management of patients who have recently been discharged from a hospital or skilled nursing facility.

The American Medical Association CPT Editorial Panel created new codes (99495 and 99496) to capture transitional care management services.

Learn more about these CPT codes here.

Sermo and the AMA on CNN's Lou Dobbs

Sermo confronts AMA on CNN's Lou Dobbs (8/13/09). A presidential misstatement spotlights AMA's dilemma in the debate over health care reform. Ines Ferre reports. More about the AMA, CPT codes, reform bills, and more. Watch this video:

Can't see the video? Visit: http://www.medicineandtechnology.com/

Things are getting ugly between Sermo and the AMA

Wow, things are starting to get quite nasty here. The marriage has turned into an ugly divorce. When Sermo announced its partnership with the AMA, I was optimistic. However, they have had an ugly split recently and they're now at war.

I just got an e-mail from Sermo's founder Dr. Daniel Palestrant. The subject line reads: "From the Founder: CPT - Why physicians always get screwed, thanks AMA"

He highlights the results of a recent survey that included over 4,000 US physicians and it generated over 700 comments on Sermo. The results are quite striking:

• 75% of physicians surveyed are not members of the AMA.
• 89% of physicians claim, "The AMA does not speak for me."
• 91% of physicians surveyed do not believe the AMA accurately reflects their opinion as physicians.

Now, the focus on Sermo is shifting towards Current Procedure Terminology (CPT) coding. Here's some background on CPT codes:

For most physicians, Current Procedure Terminology or CPT codes have become a defining aspect of how we must practice medicine. They have become the "currency" of healthcare, mandating all manner of payments to physicians from the most complex surgical procedures to routine office visits. In the process, the CPT coding system has turned into an incredibly complex system of codes, modifiers, and exceptions. Add to that the RVU formulas, and it is no wonder that most physicians are drowning in paperwork.

So, now it's time to consider some questions related to CPT codes:

• Who publishes these CPT codes?
  
• Is it right that the AMA makes more money from selling licensing for CPT codes than it does from membership dues?
  
• Should our government continue to support the AMA’s monopoly on CPT codes?
• Who should manage CPT codes?

If you're a U.S. physician, have you joined Sermo? Are you a member of the AMA?