How To Use CPT Code 96168

CPT 96168 describes the health behavior intervention provided by a psychologist or other qualified provider to the patient’s family in the presence of the patient. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 96168?

CPT 96168 can be used to describe the health behavior intervention services provided by a psychologist or other qualified provider to the patient’s family in the presence of the patient. This code represents each additional 15 minutes of face-to-face service with the patient’s family.

2. Official Description

The official description of CPT code 96168 is: ‘Health behavior intervention, family (with the patient present), face-to-face; each additional 15 minutes (List separately in addition to code for primary service).’ This code should be used in conjunction with CPT code 96167 for the initial 30 minutes of service.

3. Procedure

  1. The provider, typically a psychologist, conducts a face-to-face session with the patient’s family in the presence of the patient.
  2. The provider addresses family-related barriers to the patient’s self-management of chronic diseases.
  3. The provider discusses interventions and strategies to help the patient and family overcome factors that result in noncompliance or hinder recovery.
  4. The provider observes the patient’s behavior and interactions with family members to assess the dynamics and behaviors that affect the patient’s coping skills.
  5. The provider uses cognitive and behavioral approaches to encourage the patient and family members to change behaviors that adversely affect the patient’s coping skills and management of their medical illness.
  6. The provider discusses next steps with the patient and the family.
  7. For each additional 15 minutes of face-to-face service with the family in the presence of the patient, report CPT code 96168.

4. Qualifying circumstances

CPT 96168 is used when a psychologist or other qualified provider conducts a health behavior intervention with the patient’s family in the presence of the patient. The focus is on addressing family-related barriers to the patient’s self-management of chronic diseases. The provider uses cognitive and behavioral approaches to encourage the patient and family members to change behaviors that adversely affect the patient’s coping skills and management of their medical illness.

5. When to use CPT code 96168

CPT code 96168 should be used when a psychologist or other qualified provider conducts a health behavior intervention with the patient’s family in the presence of the patient. This code should be used for each additional 15 minutes of face-to-face service with the family. It is important to note that CPT code 96168 should be reported in conjunction with CPT code 96167 for the initial 30 minutes of service.

6. Documentation requirements

To support a claim for CPT code 96168, the provider must document the following information:

  • Specific details of the health behavior intervention provided to the patient’s family
  • Date, start and end time of the face-to-face session
  • Observations of the patient’s behavior and interactions with family members
  • Strategies discussed to help the patient and family overcome barriers to self-management
  • Next steps discussed with the patient and the family

7. Billing guidelines

When billing for CPT code 96168, ensure that the provider conducting the health behavior intervention is a psychologist or other qualified provider. Report this code for each additional 15 minutes of face-to-face service with the patient’s family in the presence of the patient. It is important to use CPT code 96167 for the initial 30 minutes of service. Do not report CPT code 96168 in conjunction with mental illness diagnosis codes or psychotherapy services codes.

8. Historical information

CPT code 96168 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 health behavior intervention with the patient’s family in the presence of the patient to address family dynamics and behaviors that adversely affect the patient’s physical health and coping behaviors.
  2. A qualified provider discussing strategies with the patient’s family to change behaviors that hinder the patient’s recovery from a chronic illness during a face-to-face session.
  3. A psychologist observing the patient’s interactions with family members and using cognitive and behavioral approaches to encourage the patient and family members to change behaviors that affect the patient’s coping skills and management of their medical illness.
  4. A provider addressing intellectual, cultural, psychophysiological, and emotional factors that result in noncompliance or hinder recovery during a health behavior intervention with the patient’s family in the presence of the patient.
  5. A psychologist discussing interventions and strategies with the patient’s family to help the patient overcome barriers to self-management of their chronic disease during a face-to-face session.
  6. A qualified provider conducting a health behavior intervention with the patient’s family in the presence of the patient to address health-related risky behaviors and promote health-promoting behaviors.
  7. A psychologist observing the patient’s physical and emotional responses to family members and using 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.
  8. A provider discussing next steps with the patient and the family after a health behavior intervention session to ensure continued progress and improvement in the patient’s self-management of their chronic disease.

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