How To Use CPT Code 96167

CPT 96167 describes the health behavior intervention provided by a psychologist or qualified provider to a patient’s family in the presence of the patient. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 96167?

CPT 96167 can be used to describe the initial 30-minute health behavior intervention session provided by a psychologist or qualified provider to a patient’s family in the presence of the patient. This code is used when the provider addresses family-related barriers to self-management of the patient’s chronic disease(s) and counsels the family on strategies to change family dynamics and behaviors that adversely affect the patient’s physical health and coping behaviors.

2. Official Description

The official description of CPT code 96167 is: ‘Health behavior intervention, family (with the patient present), face-to-face; initial 30 minutes.’

3. Procedure

1. The provider, typically a psychologist, conducts a 30-minute face-to-face session with the patient’s family in the presence of the patient.
2. The provider addresses family-related barriers to self-management of the patient’s chronic disease(s) and counsels the family on strategies to change family dynamics and behaviors that adversely affect the patient’s physical health and coping behaviors.
3. The provider asks questions about the patient’s interactions with family members, observes the patient’s behavior in response to questions or situations, and observes how the patient responds physically and emotionally to the family members and how they respond to the patient’s statements and behavior.
4. The provider uses cognitive and behavioral approaches to encourage the patient and family members to change family dynamics and behaviors that adversely affect the patient’s coping skills and management of the patient’s medical illness.
5. The provider discusses next steps with the patient and the family.

4. Qualifying circumstances

CPT 96167 is used when the provider, typically a psychologist, conducts a 30-minute face-to-face session with the patient’s family in the presence of the patient. The session aims to address family-related barriers to self-management of the patient’s chronic disease(s) and counsel the family on strategies to change family dynamics and behaviors that adversely affect the patient’s physical health and coping behaviors.

5. When to use CPT code 96167

CPT code 96167 should be used when a psychologist or qualified provider conducts an initial 30-minute health behavior intervention session with the patient’s family in the presence of the patient. This code is appropriate when the session focuses on addressing family-related barriers to self-management of the patient’s chronic disease(s) and counseling the family on strategies to change family dynamics and behaviors that adversely affect the patient’s physical health and coping behaviors.

6. Documentation requirements

To support a claim for CPT 96167, the provider must document the following information:

• Specific details about the patient’s chronic disease(s) and the need for family intervention
• Date, start and end time of the 30-minute face-to-face session
• Observations and interactions between the patient, family members, and the provider
• Strategies discussed and recommended to change family dynamics and behaviors
• Next steps and follow-up plans
• Signature of the provider conducting the session

7. Billing guidelines

When billing for CPT 96167, ensure that the provider conducting the session is a psychologist or qualified provider. The session should be face-to-face with the patient’s family in the presence of the patient for 30 minutes. It is important to note that CPT code 96167 should not be reported with mental illness diagnosis codes or psychotherapy services codes. For additional 15-minute increments of face-to-face health behavior intervention with the patient’s family, report CPT code 96168 along with CPT code 96167 for the initial 30 minutes.

8. Historical information

CPT 96167 was added to the Current Procedural Terminology system on January 1, 2020. There have been no updates to the code since its addition.

9. Examples

1. A psychologist conducting a 30-minute face-to-face health behavior intervention session with the family of a patient with diabetes, addressing family dynamics and behaviors that affect the patient’s self-management.
2. A qualified provider conducting an initial 30-minute session with the family of a patient with asthma, discussing strategies to improve family support and reduce environmental triggers.
3. A psychologist conducting a 30-minute face-to-face session with the family of a patient with chronic pain, addressing family dynamics and behaviors that impact the patient’s pain management and coping skills.
4. A qualified provider conducting an initial 30-minute health behavior intervention session with the family of a patient with hypertension, discussing lifestyle modifications and strategies to improve medication adherence.
5. A psychologist conducting a 30-minute face-to-face session with the family of a patient with anxiety, addressing family dynamics and behaviors that contribute to the patient’s stress levels and coping mechanisms.
6. A qualified provider conducting an initial 30-minute health behavior intervention session with the family of a patient with COPD, discussing strategies to improve family support and enhance the patient’s self-management of symptoms.
7. A psychologist conducting a 30-minute face-to-face session with the family of a patient with heart failure, addressing family dynamics and behaviors that impact the patient’s self-monitoring techniques and adherence to treatment plans.