Vivian Marlowe
Alcohol abuse and dependence are serious issues that can lead to a range of health complications. To ensure proper diagnosis and treatment, medical professionals use specific codes when billing for alcohol-related services. These codes are essential for psychologists and other practitioners to receive reimbursement for their work. The CMS-835 form is one such tool used to report brief alcohol abuse interventions, typically lasting 15-30 minutes, and involving structured assessments and screening tools such as AUDIT and DAST. This paragraph aims to provide an introduction to the topic of diagnostic coding for alcohol-related issues on the CMS-835 form, highlighting the importance of accurate coding in healthcare settings.
| Characteristics | Values |
|---|---|
| ICD-10-CM diagnosis code | Z13.89, Z02.83 |
| ICD-10-CM diagnosis code for alcohol use, abuse, or dependence | F10.- |
| CPT code for alcohol and/or substance abuse structured assessment and brief intervention (SBI) service (15-30 minutes) | 99408 |
| CPT code for alcohol and/or substance abuse structured assessment and brief intervention (SBI) service (more than 30 minutes) | 99409 |
| CPT code for psychiatric diagnostic interview | 90791 |
| CPT code for brief (15-30 minutes) alcohol and/or substance abuse intervention | G0396 |
| CPT code for brief (5-14 minutes) alcohol and/or substance abuse intervention | G0397 |
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What You'll Learn
CPT codes for alcohol abuse counselling
CPT codes are used for billing and insurance reimbursement purposes for healthcare services rendered. CPT codes for alcohol abuse counselling can be used for a range of mental health services, including substance abuse counselling. CPT codes for alcohol abuse counselling include:
- CPT codes 90832-99404: These codes cover a wide range of mental health services, including individual or group counselling sessions that focus on alcohol abuse and last 15 minutes or less, or 30 minutes or more.
- CPT code 99409: This code is for alcohol screening that lasts longer than 30 minutes, followed by a brief intervention to prevent AUD.
- CPT codes 99408: This code is for alcohol screening that lasts 15-30 minutes.
- CPT codes 99202-99205: These codes are for new patient E/M visits.
- CPT code 90791: This code is for an initial psychiatric evaluation.
- CPT code 90833: This code is for an add-on individual psychotherapy.
- CPT codes 96132/+96133: These codes are for neuropsychological evaluation services.
- CPT code G0396: This code indicates the performance of 15-30 minutes of SBIRT services.
- CPT code G0397: This code indicates the performance of 30 or more minutes of SBIRT services.
It is important to note that accurate coding is essential for providers to ensure proper reimbursement, maintain compliance with coding guidelines, and effectively communicate the nature of the services rendered.
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ICD-10-CM diagnosis codes
The ICD-10-CM (International Classification of Diseases, 10th Edition, Clinical Modification) is a system used by healthcare professionals to classify and code diagnoses, symptoms, and procedures. It is a standardised system that allows for consistent documentation and billing of medical services. When it comes to alcohol-related diagnoses, the ICD-10-CM includes codes that specifically address alcohol abuse and dependence.
For uncomplicated alcohol abuse, the ICD-10-CM diagnosis code is F10.10. This code falls under the category of nondependent, episodic alcohol abuse. It became effective on October 1, 2024, as part of the 2025 ICD-10-CM updates. This code can be used for billing and reimbursement purposes and is applicable to the American version of ICD-10-CM. However, it's important to note that international versions of the code may differ.
Additionally, the ICD-10-CM code F10.20 represents uncomplicated alcohol dependence. Similar to the previous code, F10.20 is also billable and specific for diagnosis and reimbursement. The effective date of this code is the same as F10.10, and it follows the same guidelines for the American and international versions.
The ICD-10-CM has specific coding conventions for alcohol-related disorders (F10*). When coding these conditions, the underlying condition must be sequenced first, followed by the manifestation. In most cases, the manifestation codes will be indicated by the phrase "in diseases classified elsewhere." These codes cannot be used as the first-listed or principal diagnosis and must be linked to an underlying condition code. For example, "Y90 Evidence of alcohol involvement determined by..." indicates the involvement of alcohol and would be coded accordingly.
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Medicare billing rules
When billing Medicare for alcohol or substance abuse screening and brief intervention services, it is important to use the correct diagnostic codes to ensure reimbursement. The diagnostic code for alcohol abuse is F10.10, which is listed in the International Classification of Diseases (ICD-10-CM) manual. This manual is used to assign codes to diagnoses related to a patient's condition and plays a crucial role in medical billing and reimbursement.
To correctly bill Medicare for alcohol abuse screening and brief intervention services, practitioners should follow these steps:
- First, ensure that the patient meets the criteria for an alcohol abuse diagnosis, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual provides the diagnostic criteria for mental health professionals and includes specific guidelines for substance-related and addictive disorders.
- Second, administer a valid and reliable alcohol abuse screening tool, such as the Alcohol Use Disorders Identification Test. This test helps assess the patient's alcohol consumption, drinking behaviour, and any related problems or consequences.
- Third, document the patient's results from the screening tool and any additional assessments conducted as part of the structured assessment process. This documentation should include the patient's score on the screening tool and any relevant clinical information that supports the diagnosis.
- Fourth, determine the appropriate level of intervention based on the patient's severity of alcohol abuse. This could range from brief intervention, which involves providing feedback and advice to the patient, to referral for specialised treatment or additional diagnostic evaluations.
- Finally, submit the claim to Medicare using the correct diagnostic code (F10.10) and procedure codes that reflect the services provided. Ensure that the services provided meet Medicare's requirements for reimbursement, as outlined by their coverage policies and local coverage determinations.
By following these Medicare billing rules and guidelines, practitioners can ensure accurate reimbursement for alcohol abuse screening and brief intervention services, contributing to improved patient care and better outcomes for individuals with alcohol-related issues.
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SBIRT services
SBIRT, or Screening, Brief Intervention, and Referral to Treatment, is an evidence-based approach to identify individuals who use alcohol and other drugs at risky levels. It is a public health approach that can deliver an early intervention to anyone who uses alcohol and/or drugs in unhealthy ways.
The SBIRT model was incited by an Institute of Medicine (IOM) recommendation that called for community-based screening for health risk behaviours, including substance use. It is designed to be used by many types of staff in a variety of settings, including clinics, schools, and community centres.
The Screening phase involves a short, well-tested questionnaire that identifies the risk level of an individual's substance use. This can include tools such as the ASSIST, CRAFFT, AUDIT, and DAST. The Brief Intervention involves a short, structured conversation with the individual to review the screening results and elicit their motivation to either continue making healthier choices or to make changes. This conversation is non-judgmental and features feedback and options for change. If screening shows no risk, the goal of the Brief Intervention is to provide reinforcement and information to encourage healthy choices.
If further treatment is required, the Referral phase involves providing a referral to brief therapy or additional treatment services. This can include an in-depth assessment, diagnosis, or treatment if needed. Between 1% and 10% of individuals may need some level of treatment, depending on the healthcare setting.
Reimbursement codes for SBIRT services were developed in 2009, and some payers do recognize them. Medicare reimburses for alcohol SBI as part of a prevention visit, using G-codes which differ from CPT codes.
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FASD coding basics
The International Statistical Classification of Diseases (ICD) diagnosis codes are used to support the medical necessity for performing a service. The physician must clearly indicate the reason for all the services rendered to ensure the most specific code is selected. When selecting ICD-10-CM diagnostic codes, the clinical need for the service, as described by the Current Procedural Terminology (CPT) code linked to the diagnosis, must be reflected.
For any pregnancy case in which the mother uses alcohol during pregnancy and postpartum, codes from subcategory O99.31-, Alcohol use complicating pregnancy, childbirth and puerperium, should be assigned. These codes refer to the mother only and are never assigned to the newborn's record.
A secondary code from category F10.-, Alcohol-related disorders, should also be used to identify manifestations of alcohol use. A code from this section would be used for a diagnosis of alcohol use, abuse, or dependence. Per ICD-10-CM guidelines, only one code should be used to identify the pattern of use. If both use and abuse are documented, only the code for abuse should be used. If both abuse and dependence are documented, only the code for dependence should be used.
Chapter 15 of ICD-10-CM includes codes for conditions that affect the management of pregnancy, childbirth, and the puerperium. These codes take precedence over codes from other chapters, but additional codes from other chapters may be used when needed to provide more specificity or additional context.
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Frequently asked questions
Z13.89, Z02.83, and O99.31- are some of the ICD-10-CM diagnosis codes that may be reported for alcohol screening.
CPT codes 99408 and 99409 are used for alcohol abuse counseling services.
Report CPT code 90791 for the psychiatric diagnostic interview and G0396 for the performance of 15–30 minutes of SBIRT services.
SBIRT stands for Screening, Brief Intervention, and Referral to Treatment. It is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for substance use disorders.
