Are you performing a alcohol misuse screening on your Medicare patients when they come in for their annual wellness visit (AWV)? If not, you might consider adding it as it has a B grade from the U.S. Preventive Services Task Force (USPSTF) and is recommended to be done yearly.
The alcohol misuse screening must be done in a primary care setting and there are many screening tools that can be used. The form found here is a form that could be used for the alcohol misuse screening. You can verbally ask the patient these questions or have them fill out the form while they wait for their appointment.
The provider should review the results with the patient during their AWV to clarify any responses if needed. Each answer has a corresponding score and all lines should be totaled in order to get the overall score (maximum score is 40). Men under the age of 60 who score 8 or more, women and men over 60 who score 4 or more are considered positive screens.
For those that screen positive, providers should conduct brief, face-to-face, behavioral counseling interventions up to 4 times per year. The counseling should be in line with the 5A's approach as used by USPSTF which are:
Assess: Assess or ask about behavioral health risk(s) and factors affecting choice of behavior
Advise: Give clear, specific, and personalized behavior change advice, which includes information about personal health harms and benefits
Agree: Collaboratively select appropriate treatment goals and methods based on the patient's interest in and willingness to change the behavior
Assist: Using behavior change techniques (self-help and/or counseling), assist the patient in achieving the agreed upon goals by helping the patient acquire the skills, confidence, and social/environmental supports for behavior change, supplemented with adjunctive medical treatments when appropriate
Arrange: Schedule follow-up contacts (in person or by phone) to provide ongoing support/assistance and to adjust the treatment plan as needed, including referral to more intensive or specialized treatment
This screening, along with the counseling, is covered 100% by Medicare and it will not be subject to the patient's Medicare deductible or coinsurance. Once you have performed this screening, or counseling, here is what you bill:
G0442 - Annual alcohol misuse screening, 15 minutes (covered once every 12 months)
G0443 - Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes (covered 4 times every 12 months for patients who screen positive for alcohol misuse)
ICD-10 code Z13.89 should be used for the screening with an appropriate alcohol abuse/misuse ICD-10 code assigned to G0443
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Sources: CMS NCD 210.8
NIAA - Clinician Support Materials
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