CPT Code 96136

[Fox800]

Interesting discussion with another physician recently. They are having patients fill out a PROMIS-29 inventory on an iPad in the waiting room. They then track the inventory scores, document it in the chart, and bill this code.

Anyone else doing this? On top of G2211? Thoughts?

“CPT Code 96130:
CPT code 96130 is used for psychological testing evaluation services by a physician or other qualified healthcare professional. This code includes the administration and interpretation of standardized tests and measures, and the integration of the data into a diagnostic and treatment plan.”

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[BoardingDoc]

Interesting discussion with another physician recently. They are having patients fill out a PROMIS-29 inventory on an iPad in the waiting room. They then track the inventory scores, document it in the chart, and bill this code.

Anyone else doing this? On top of G2211? Thoughts?

“CPT Code 96130:
CPT code 96130 is used for psychological testing evaluation services by a physician or other qualified healthcare professional. This code includes the administration and interpretation of standardized tests and measures, and the integration of the data into a diagnostic and treatment plan.”

Unless this person is creating a psychiatric treatment plan after reviewing each score, this seems like fraud.

Also, the only icd10 diagnoses that seem to justify using this code are all psych. That said, it does include substance abuse.

Article - Billing and Coding: Psychological and Neuropsychological Tests (A57780)

Use this page to view details for the Local Coverage Article for Billing and Coding: Psychological and Neuropsychological Tests.

www.cms.gov

I suppose if you're writing opioids, you can use opioid dependency as an icd10 code and then use this tool to BS some plan which is basically "keep writing them narcs, but I'll totally keep a close eye on them"

I don't see another remotely legitimate way to do this. And the way that I just came up with feels really gross, and made me turn to my wife and repeat something I say a lot: "man, I could make so much more freaking money if I didn't have morals."

 

[Fox800]

I’m thinking it’s actually 96146

CPT 96146​

CPT Code 96146 is used when tests are administered by a computer and is defined as “Psychological or neuropsychological test administration, with single automated instrument via electronic platform, with automated result only”. Note specifically that this code is for use with a single automated instrument via electronic platform, with automated result only.

 

[BobBarker]

Yes, I have been presented the “opportunity” to get paid for psych screen many times.

 

[PMROralBoards]

Old clinic started to do this and I refused. It doesn’t change my management of the patient and it feels scummy.

 

[BoardingDoc]

I’m thinking it’s actually 96146

CPT 96146​

CPT Code 96146 is used when tests are administered by a computer and is defined as “Psychological or neuropsychological test administration, with single automated instrument via electronic platform, with automated result only”. Note specifically that this code is for use with a single automated instrument via electronic platform, with automated result only.

96146 has 0 wRVUs attached to it and it looks like the total reimbursement is approximately $2. There is no way this is a good use of time.

 

[kstarm]

Interesting discussion with another physician recently. They are having patients fill out a PROMIS-29 inventory on an iPad in the waiting room. They then track the inventory scores, document it in the chart, and bill this code.

Anyone else doing this? On top of G2211? Thoughts?

“CPT Code 96130:
CPT code 96130 is used for psychological testing evaluation services by a physician or other qualified healthcare professional. This code includes the administration and interpretation of standardized tests and measures, and the integration of the data into a diagnostic and treatment plan.”

I am curious if you could just use a PHQ 4 or PHQ-9 which we get on nearly every patient. I think it would be very easy to argue that those results fit this code. 0.55 wRVU for those interested.

EDIT: Looks like brief inventories don't count

 

[Gauss]

I am curious if you could just use a PHQ 4 or PHQ-9 which we get on nearly every patient. I think it would be very easy to argue that those results fit this code. 0.55 wRVU for those interested.

EDIT: Looks like brief inventories don't count

still fraudulent, you will lose an audit. These codes are for testing when a medical or mental health evaluation has been conducted and a specific diagnostic or treatment question still exists that cannot be answered by a psych history and diagnostic interview. You have to send itemized list of tests performed and time spent administering, interpreting tests and preparation of report. Most plans have max reimbursement of 1 per year and they are billed as a function of time. These codes are meant for mental health professionals.

 

[drusso]

Interesting discussion with another physician recently. They are having patients fill out a PROMIS-29 inventory on an iPad in the waiting room. They then track the inventory scores, document it in the chart, and bill this code.

Anyone else doing this? On top of G2211? Thoughts?

“CPT Code 96130:
CPT code 96130 is used for psychological testing evaluation services by a physician or other qualified healthcare professional. This code includes the administration and interpretation of standardized tests and measures, and the integration of the data into a diagnostic and treatment plan.”

Hire a behavioral health specialist or pay for your wife to go get her Master's in psychology or social work and employ her.

 

[PainMD23]

Consider 96127. However, 96130 unlikely to fly. Agree with drusso

 

[Gauss]

Hire a behavioral health specialist or pay for your wife to go get her Master's in psychology or social work and employ her.

LCSW, LPCC, LMFT ain't gonna work for these codes, not qualified to administer interpret and write the report. really only for licensed psychologist or psychiatrist

 

[Gauss]

Consider 96127. However, 96130 unlikely to fly. Agree with drusso

this can work, note it's specific for brief behavioral/emotional assessment

 

[drusso]

LCSW, LPCC, LMFT ain't gonna work for these codes, not qualified to administer interpret and write the report. really only for licensed psychologist or psychiatrist

LCSW works. Trust me.

 

[1 Up]

Interesting discussion with another physician recently. They are having patients fill out a PROMIS-29 inventory on an iPad in the waiting room. They then track the inventory scores, document it in the chart, and bill this code.

Anyone else doing this? On top of G2211? Thoughts?

“CPT Code 96130:
CPT code 96130 is used for psychological testing evaluation services by a physician or other qualified healthcare professional. This code includes the administration and interpretation of standardized tests and measures, and the integration of the data into a diagnostic and treatment plan.”

We use 96136, requires administering 2 psychological or neuropsychological tests (GAD-7 and PHQ-9), and at least 50% of 30 minutes (so, >15 minutes) in the patient completing the test, and your interpretation of test results.

You cannot bill -25 with G2211 unless is a part B preventative services (e.g. tobacco cessation counseling - 99406). So if you bill 96136, you cannot bill G2211.