American College of Physicians: Internal Medicine — Doctors for Adults ®

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Tools to screen for alcohol abuse

From the September ACP Internist, copyright © 2012 by the American College of Physicians

One in eight adults has an alcohol problem, and four in 10 seniors drink alcohol. Medicare will pay for screening for problem drinking patterns as part of the Annual Wellness Visit, and a few easy-to-follow tips can help physicians identify potentially problematic behavior.

Medicare began covering alcohol misuse screening in October 2011. Medicare will also reimburse for up to four brief face-to-face behavioral counseling interventions for adult beneficiaries, including pregnant women, who screen positive and are covered under the fee-for-service program.

In terms of practice management, screening and interventions must be performed by a qualified primary care physician or other primary care practitioner in a primary care setting. The service code for alcohol screening is G0442, and the code for the brief counseling interventions is G0443. Medicare can be billed for both codes if they occur on the same day. Because this is a Medicare preventive service, there is no deductible or co-insurance payment required from the beneficiary. (More information on coding for these services is available online.)

In terms of clinical interventions, the National Institute on Alcohol Abuse and Alcoholism's (NIAAA) Alcohol Screening and Brief Intervention guide (available online) is a quick, two-question screening tool that will give a good idea of your patients' level of risk for alcohol-related problems. Two follow-up tools to consider include the 10-question AUDIT (Alcohol Use Disorders Identification Test), available online, and the six-question CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble), available online.

Both of these tools can be administered on paper; CRAFFT can also be verbally administered in the office. A paper-based version of either tool can be completed by the patient in the waiting room and then scored by the appropriate staff before the patient sees the physician or primary care practitioner.

If a patient tests positive for alcohol misuse, but for not alcohol dependence, consider brief face-to-face counseling interventions. These interventions must be consistent with the “five A's” approach recommended by the U.S. Preventive Services Task Force: Assessing the condition, Advising on behavior change, Agreeing on appropriate treatment goals, Assisting with behavior change techniques and Arranging for follow-up support.

NIAAA's Alcohol Screening and Brief Intervention guide is also a great tool for aiding in the brief counseling interventions. If a patient screens positive for alcohol dependence, consider referring the patient to a specialist for further evaluation and follow-up.

For more information

The Centers for Medicare and Medicaid Services offers “Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse” to inform physicians and other clinicians about this new Medicare benefit. To access it online, place code 7633 in the Medicare MLN Matters document search tool available online.

Information on the Annual Wellness Visit is available from ACP's Center for Practice Improvement & Innovation online.

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