Some Substance Abuse Interventions May Get New CPT Codes

The AMA's CPT Editorial Panel has approved codes that may be used for brief individual behavior change interventions to address alcohol abuse and smoking.

Psychiatrist Tracy Gordy, M.D., who is chair of the CPT Editorial Panel, cautioned that the new codes are not final and must still be assigned a value by the AMA's Relative Value Scale Update Committee, which meets in June.

They will become final when the CPT manual is published in the fall. Moreover, the Centers for Medicare and Medicaid Services must decide to accept them for reimbursement under the 2008 Medicare physician fee schedule, also in the fall. In the meantime, the wording of the codes may also change, Gordy told Psychiatric News.

Gordy said he believes that the new codes would not likely be valued as highly as some other codes—especially existing evaluation and management codes for counseling and psychotherapy—that would more likely be used by psychiatrists. Still, if ultimately approved, they could be used by psychiatrists and other physicians or health care clinicians.

The new codes are currently titled “Behavior Change Interventions, Individual” with two codes under that title for brief interventions and longer interventions: for alcohol and substance-abuse structured screening and brief intervention services, there is one code for a 15-to-30 minute intervention and a separate code for interventions longer than 30 minutes.

Likewise, for counseling for smoking and tobacco-use cessation, there is one code for an intervention of three to 10 minutes and a second code for interventions longer than 10 minutes.

The new codes currently appear within the evaluation and management section of the CPT under “Counseling and/or Risk Factor and Behavior Change Intervention, for a New or Established Patient.”

According to the text introducing the new codes, they are to be used to“ report services provided face to face by a physician or other qualified health professional to individuals at a separate encounter for the purpose of promoting health and preventing illness or injury.

“Behavior change interventions are for persons who have a behavior that is often considered an illness itself, such as tobacco use and addiction, substance abuse/misuse, or obesity. Behavior change services may be reported when performed as part of the treatment of condition(s) related to or potentially exacerbated by the behavior, or when performed to change the harmful behavior that has not yet resulted in illness.” ▪