How To Use CPT Code 96160

CPT 96160 is a code used for the administration of patient-focused health risk assessment instruments, including scoring and documentation. This article will cover topics such as the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 96160 procedures.

1. What is CPT 96160?

CPT 96160 is a medical billing code used to represent the administration of a patient-focused health risk assessment instrument, such as a health hazard appraisal, with scoring and documentation. This code is used when a healthcare provider administers a standardized questionnaire to a patient to help identify specific health risks, analyzes the results, assigns a score, and documents the findings.

2. 96160 CPT code description

The official description of CPT code 96160 is: “Administration of patient-focused health risk assessment instrument (e.g., health hazard appraisal) with scoring and documentation, per standardized instrument.”

3. Procedure

The 96160 CPT code procedure involves the following steps:

1. The healthcare provider selects an appropriate standardized health risk assessment instrument for the patient.
2. The patient completes the questionnaire, providing information about their health and lifestyle.
3. The healthcare provider reviews the patient’s responses and analyzes the results.
4. A score is assigned to the patient’s health risk based on the assessment instrument’s criteria.
5. The healthcare provider discusses the results with the patient and provides recommendations for managing or reducing identified health risks.
6. The provider documents the assessment instrument used, the patient’s score, and any related discussions or recommendations in the patient’s medical record.

4. Qualifying circumstances

Patients eligible to receive CPT code 96160 services are those who may be at risk for developing specific health issues or conditions. These patients may have a family history of certain diseases, exhibit risk factors such as obesity or smoking, or have a history of exposure to environmental hazards. The healthcare provider determines the appropriateness of administering a health risk assessment instrument based on the patient’s medical history, current health status, and potential risk factors.

5. When to use CPT code 96160

It is appropriate to bill the 96160 CPT code when a healthcare provider administers a standardized patient-focused health risk assessment instrument, scores the results, and documents the findings in the patient’s medical record. This code should be used for each standardized survey questionnaire administered, as long as the criteria are established and agreed upon by a group of experts.

6. Documentation requirements

To support a claim for CPT 96160, the following information should be documented in the patient’s medical record:

• The specific standardized health risk assessment instrument used.
• The patient’s responses to the questionnaire.
• The healthcare provider’s analysis of the results and assigned score.
• A summary of the discussion between the provider and patient regarding the results and any recommendations for managing or reducing identified health risks.
• Any follow-up appointments or referrals made based on the assessment results.

7. Billing guidelines

When billing for CPT code 96160, it is important to remember that the code includes the administration of the standardized questionnaire, scoring, and documentation. Separate billing for scoring and report preparation is not allowed. Additionally, if a similar instrument is administered to a patient’s caregiver, such as for assessing the patient’s risk of developing depression, CPT code 96161 should be used instead.

8. Historical information

CPT 96160 was added to the Current Procedural Terminology system on January 1, 2017. There have been no updates to the code since its addition.

9. Similar codes to CPT 96160

Five similar codes to CPT 96160 and how they differentiate are:

1. CPT 96161: This code is used for the administration of a caregiver-focused health risk assessment instrument, such as a depression inventory, for the benefit of the patient.
2. CPT 96127: This code is used for the administration of a brief emotional/behavioral assessment with scoring and documentation.
3. CPT 96138: This code is used for the administration and scoring of psychological or neuropsychological tests by a technician.
4. CPT 96146: This code is used for the administration of a computerized adaptive psychological or neuropsychological test with a qualified health professional’s interpretation and report.
5. CPT 96150: This code is used for an initial health and behavior assessment conducted by a healthcare professional.

10. Examples

Here are 10 detailed examples of CPT code 96160 procedures:

1. A healthcare provider administers a cardiovascular risk assessment questionnaire to a patient with a family history of heart disease.
2. A patient with a history of smoking completes a lung cancer risk assessment instrument under the guidance of their healthcare provider.
3. A healthcare provider administers a diabetes risk assessment questionnaire to a patient with obesity and a sedentary lifestyle.
4. A patient with a history of exposure to hazardous chemicals completes an occupational health risk assessment instrument.
5. A healthcare provider administers a mental health risk assessment questionnaire to a patient experiencing high levels of stress.
6. A patient with a family history of osteoporosis completes a bone health risk assessment instrument.
7. A healthcare provider administers a nutrition risk assessment questionnaire to a patient with a history of poor dietary habits.
8. A patient with a history of alcohol abuse completes a liver disease risk assessment instrument.
9. A healthcare provider administers a skin cancer risk assessment questionnaire to a patient with a history of sunburns and tanning bed use.
10. A patient with a family history of Alzheimer’s disease completes a cognitive decline risk assessment instrument.