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SUBSTANCE ABUSE TREATMENT CODES TO MEET HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) REQUIREMENTS. Kathleen M. Nardini, M.A. HIPAA Coordinator The National Association of State Alcohol and Drug Abuse Directors (NASADAD) . NASADAD.
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SUBSTANCE ABUSE TREATMENT CODES TO MEET HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) REQUIREMENTS Kathleen M. Nardini, M.A. HIPAA Coordinator The National Association of State Alcohol and Drug Abuse Directors (NASADAD)
NASADAD • Private not-for-profit educational, scientific, informational organization • Composed of Directors of State Alcohol and Drug Abuse (AOD) Agencies • Foster and support development of effective AOD prevention and treatment programs • Focal point for other related AOD issues
OVERVIEW • NASADAD led the national substance abuse code development effort to meet HIPAA requirements • Centers for Medicaid and Medicare (CMS) approved substance abuse, generic behavioral health, modifier, and mental health Health Care Common Procedure Coding System (HCPCS) codes • Compliance Date - October 16, 2003
HIPAA • HIPAA promotes standardization and efficiency in the health care system • HIPAA Administrative Simplification • Electronic transactions and code sets standards requirements • Privacy requirements • Security requirements • National Identifier requirements
NEED FOR NATIONAL CODES • Electronic Transactions and Code Sets • Under HIPAA existing standard code sets were adopted but none existed for the substance abuse and mental health field • NASADAD AND NASMHPD worked with their members to develop, request, and seek approval for new codes
DEVELOPMENT PROCESSWORKGROUP MEETINGS • State workgroup meetings and calls • Review of treatment and prevention services delivered across States • Identification and definition of proposed National codes • Development of code submission package with justification for each code
DEVELOPMENT PROCESSCMS APPROVAL PROCEDURE • CMS advisory group review code submission • CMS recommends modifications • CMS forwards revised code submission to National Review Panel • CMS National Review Panel approves or disapproves codes • CMS posts approved codes on Web site
THREE CODE SUBMISSIONS • Ohio State AOD Agency on behalf of NASADAD code package request in 2000 • NASADAD code package request in March 2001 • NASADAD/NASMHPD joint code package request in February 2002
HCPCS CODES • 2000 Submission - 30 AOD procedure codes requested and approved • 2001 Submission - 20 AOD procedure and 8 modifier code sets requested - 8 procedure codes approved • 2002 Joint NASADAD/NASMHPD Submission - Revised AOD procedure, behavioral health, modifier, and mental health codes - most of the codes approved, some codes modified to a more generic form
TABLE OF HCPCS CODES • NASADAD Periodic HCPCS Code Status Update (April 1, 2003) • Three code submission requests • Change status • Approval date • Modification date • Effective date • Not approved
SUBSTANCE ABUSE CODES • H0001 Alcohol and/or Drug Assessment • H0003 Alcohol and/or Drug Screening; Laboratory Analysis of specimens for presence of Alcohol and/or Drugs • H0005 Alcohol and/or Drug Services; Group Counseling by a Clinician • H0006 Alcohol and/or Drug Services; Case Management • H0007 Alcohol and/or Drug Services; crisis intervention (outpatient) • H0008 Alcohol and/or drug services; sub-acute detoxification (hospital inpatient)
SUBSTANCE ABUSE CODES • H0009 Alcohol and/or drug services; acute detoxification (hospital inpatient) • H0010 Alcohol and/or drug services; sub-acute detoxification (residential addiction program inpatient) • H0011 Alcohol and/or drug services; acute detoxification (residential addiction program inpatient) • H0012 Alcohol and/or drug services; sub-acute detoxification (residential addiction program outpatient
SUBSTANCE ABUSE CODES • H0013 Alcohol and/or drug services; acute detoxification (residential addiction program outpatient) • H0014 Alcohol and/or drug services; ambulatory detoxification • H0015 Alcohol and/or drug services; intensive outpatient treatment (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan) including assessment, counseling, crisis intervention, and activity therapies or education
SUBSTANCE ABUSE CODES • H0016 Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting) • H0020 Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) • H0021 Alcohol and/or drug training service (for staff and personnel not employed by providers) • H0022 Alcohol and/or drug intervention • H0026 Alcohol and/or drug prevention process service, community-based (delivery of services to deliver skills of impactors)
SUBSTANCE ABUSE CODES • H0027 Alcohol and/or drug prevention environmental service (broad range of external activities geared toward modifying systems in order to main stream prevention through policy and law) • H0028 Alcohol and/or drug prevention problem identification and referral service (e.g. student assistance and employee assistance programs), does not include assessment • H0029 Alcohol and/or drug prevention alternatives service (services for populations that exclude alcohol and other drug use e.g. alcohol free social events) • H0047 Alcohol and/or other drug abuse services, not otherwise specified
SUBSTANCE ABUSE CODES • T0048 Alcohol and/or other drug testing: collection and handling only, specimens other than blood H2034 Alcohol and/or drug abuse halfway house services, per diem • H2035 Alcohol and/or drug treatment program per hour • H2036 Alcohol and/or drug treatment program, per diem • H2037 Developmental delay, prevention activities, dependent child of client, per 15 min • T1006 Alcohol and/or substance abuse services, family /couple counseling
SUBSTANCE ABUSE CODES • T1007 Alcohol and/or substance abuse services, treatment plan development and /or modification • T1009 Child sitting services for the children of the individual receiving alcohol and/or substance abuse • T1010 Meals for individuals receiving alcohol and/or substance abuse services (when meals are not included in the program) • T1012 Alcohol and/or substance abuse services, skills development • T1013 Sign language or oral interpreter for alcohol and/or substance abuse services
BEHAVIORAL HEALTH CODES • H0002 Behavioral health screening to determine eligibility for admission to treatment program • H0004 Behavioral health counseling and therapy, per 15 min. • H0017 Behavioral health; residential (hospital residential treatment program), without room and board, per diem • H0018 Behavioral health; short-term residential (non hospital (non hospital residential treatment program) without room and board, per diem
BEHAVIORAL HEALTH CODES • H0019 Behavioral health; long term residential (non-medical, non-acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem • H0023 Behavioral health outreach service (planned approach to reach a targeted population) • H0024 Behavioral health prevention information dissemination service (one-way direct or non-direct contact with service audiences to affect knowledge and attitude)
BEHAVIORAL HEALTH CODES • H0025 Behavioral health prevention education service (delivery of services with target population to affect knowledge, attitude, and/or behavior) • H0030 Behavioral health hotline service • H2012 Behavioral health day treatment, per hour
MODIFIER CODES • HA Child/adolescent program • HB Adult program, non-geriatric • HC Adult program, geriatric • HD Pregnant/parenting women’s program • HE Mental health program • HF Substance abuse program • HG Opioid addiction treatment program • HH Integrated mental health/substance abuse program
MODIFIER CODES • HI Integrated mental health and mental retardation/developmental/disabilities • HJ Employee assistance program • HK Specialized mental health programs for high-risk populations • HL Intern • HM Less than bachelors degree • HN Bachelors degree level • HO Masters degree level • HP Doctoral level
MODIFIER CODES • HQ Group setting • HR Family/couple with client present • HS Family/couple without client present • UK Services provided on behalf of a client to someone other than the client (collateral relationship) • HT Multidisciplinary team • HU Funded by child welfare agency • HV Funded by state addictions agency • HW Funded by state mental health agency
MODIFIER CODES • HX Funded by county/local agency • HY Funded by juvenile justice agency • HZ Funded by criminal justice agency • H9 Court-ordered treatment
NASADAD HIPAA WORKGROUP MEETING • October 15 and 16, 2003 • State and Federal Representatives • Review Codes • Develop New Codes • Develop HIPAA Recommendations
NEW CODE REQUEST • Place of service codes • Local adult jail • State adult correctional facility • Federal adult correctional facility • Local juvenile detention • State juvenile detention • Street (rename) • Work setting • Behavioral health secure setting - non-jail
WORKGROUPRECOMMENDATIONS • Prepare POS code application • Develop State HIPAA Coordinators List • Develop List Serve • Develop table with all substance abuse and mental health codes • Develop guidebook with general (non-mandatory) code definitions • NASADAD lead State effort in Security document collection and information exchange • Deliver technical assistance to States
HIPAA REFERENCES • National Association of Alcohol and Drug Abuse Directors (NASADAD) www.nasadad.org • Substance Abuse and Mental Health Services Administration (SAMHSA) - www.Samhsa.gov/hipaa/index.html. • Centers for Medicare and Medicaid Services (CMS) - www.cms.gov/hipaa