How To Use CPT Code 96158

CPT 96158 refers to a health behavior intervention provided by a healthcare professional, typically a psychologist, to address cognitive, emotional, social, and cultural factors impacting a patient’s physical health in a face-to-face setting. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 96158.

1. What is CPT 96158?

CPT 96158 is a medical billing code used to describe a health behavior intervention service provided by a healthcare professional, typically a psychologist, to address cognitive, emotional, social, and cultural factors that impact the management of a patient’s physical health problems. This code is used for the initial 30 minutes of a face-to-face session with the patient.

2. 96158 CPT code description

The official description of CPT code 96158 is: “Health behavior intervention, individual, face-to-face; initial 30 minutes.”

3. Procedure

The 96158 CPT code procedure involves the following steps:

  1. The patient is referred to a psychologist or other qualified healthcare professional by their primary care physician.
  2. The provider conducts a face-to-face session with the patient, focusing on addressing barriers to self-management of the patient’s chronic disease(s).
  3. Interventions and strategies are discussed to help the patient overcome intellectual, cultural, psychophysiological, and emotional factors that result in noncompliance or hinder recovery.
  4. The provider guides the patient on improved coping skills and removal of psychological barriers to management of the patient’s chronic medical illness.
  5. The initial 30 minutes of the session are billed using CPT code 96158. For each additional 15 minutes, CPT code 96159 is used.

4. Qualifying circumstances

Patients eligible to receive CPT code 96158 services are those who:

  • Have been referred by their primary care physician to a psychologist or other qualified healthcare professional for health behavior intervention.
  • Have a diagnosed chronic physical health problem or illness that requires management.
  • Experience cognitive, emotional, social, or cultural factors that impact their ability to manage their physical health problems.
  • Require guidance on coping skills and removal of psychological barriers to improve their chronic medical illness management.

5. When to use CPT code 96158

It is appropriate to bill the 96158 CPT code when a healthcare professional, typically a psychologist, provides an initial 30-minute face-to-face health behavior intervention session with a patient to address cognitive, emotional, social, and cultural factors impacting the management of their physical health problems.

6. Documentation requirements

To support a claim for CPT 96158, the following information must be documented:

  • The patient’s referral from their primary care physician to the psychologist or other qualified healthcare professional.
  • A detailed description of the patient’s diagnosed chronic physical health problem or illness.
  • Identification of the cognitive, emotional, social, or cultural factors impacting the patient’s ability to manage their physical health problems.
  • A summary of the interventions and strategies discussed during the session to help the patient overcome these factors.
  • The duration of the face-to-face session, with the initial 30 minutes billed using CPT code 96158 and each additional 15 minutes billed using CPT code 96159.

7. Billing guidelines

When billing for CPT code 96158, keep in mind the following guidelines and rules:

  • Report CPT code 96158 for the initial 30 minutes of a face-to-face health behavior intervention session with an individual patient.
  • For each additional 15 minutes of the session, report CPT code 96159 in addition to CPT code 96158.
  • Ensure that the documentation supports the specific established underlying diagnosis and includes the required information listed in the documentation requirements section.
  • Do not report CPT code 96158 in conjunction with mental illness diagnosis codes or psychotherapy services codes.

8. Historical information

CPT 96158 was added to the Current Procedural Terminology system on January 1, 2020. There have been no updates since its addition.

9. Similar codes to CPT 96158

Five similar codes to CPT 96158 and how they differentiate are:

  • CPT 96156: Used for an initial health behavior assessment or reassessment of a patient, focusing on factors important to the treatment and management of physical health problems.
  • CPT 96159: Used for each additional 15 minutes of a face-to-face health behavior intervention session, in addition to CPT 96158 for the initial 30 minutes.
  • CPT 96164: Used for health behavior intervention services provided in a group setting, for the initial 30 minutes.
  • CPT 96167: Used for health behavior intervention services provided to a family, with the patient present, for the initial 30 minutes.
  • CPT 96170: Used for health behavior intervention services provided to a family, without the patient present, for the initial 30 minutes.

10. Examples

Here are 10 detailed examples of CPT code 96158 procedures:

  1. A patient with diabetes is referred to a psychologist for help managing their blood sugar levels due to emotional eating habits.
  2. A patient with hypertension is referred to a psychologist to address stress management techniques to improve their blood pressure control.
  3. A patient with chronic pain is referred to a psychologist to develop coping strategies for managing their pain and improving their quality of life.
  4. A patient with asthma is referred to a psychologist to address anxiety-related triggers that exacerbate their asthma symptoms.
  5. A patient with obesity is referred to a psychologist to address emotional and cultural factors contributing to their weight management difficulties.
  6. A patient with heart disease is referred to a psychologist to develop strategies for managing stress and improving their overall heart health.
  7. A patient with cancer is referred to a psychologist to address emotional and social factors impacting their ability to cope with their diagnosis and treatment.
  8. A patient with irritable bowel syndrome is referred to a psychologist to address stress management techniques to improve their gastrointestinal symptoms.
  9. A patient with chronic fatigue syndrome is referred to a psychologist to develop coping strategies for managing their fatigue and improving their daily functioning.
  10. A patient with fibromyalgia is referred to a psychologist to address emotional and cognitive factors impacting their ability to manage their pain and improve their quality of life.

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