CPT codes

[IWillSurvive]

New outpatient psychologist here...I am wondering if CPT code 96127 provides RVU credit in the VA? I am in an outpatient General MH clinic.

Also, If I give a MoCA and/or other screening measures to determine if neuropsych referral should be consulted, is there a code I should use for this? In this particular situation, it is not the initial visit. Thanks!

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[AcronymAllergy]

I don't actually know if 96127 provides wRVU credit in VA, but I would imagine it does.

I don't know of a separate code to use for cognitive screening measures. As most of my interviews are 96116, when I use a screener, it just gets folded into that.

 

[SportsNeuroPsych]

Agree with above re: MoCA. If it is just a MoCA in the context of a clinical interview than 96116 should suffice.

 

[WisNeuro]

Pssh, it's the VA, doesn't matter which codes you use 😉

 

[Sanman]

For those not billing a 96116, I am curious if a 90834+96127 can be billed if doing a MOCA or a mood measure in session.

 

[AcronymAllergy]

For those not billing a 96116, I am curious if a 90834+96127 can be billed if doing a MOCA or a mood measure in session.

My (brief) reading of 96127 seems to suggest it can be used in addition to therapy codes (once per measure administered, apparently), but is restricted to behavioral/emotional assessment instruments. I don't know if the MoCA/MMSE/SLUMS/etc. would count. Which is odd, because a MoCA is a bit more labor-intensive to administer than, say, a PHQ-9.

 

[WisNeuro]

The work RVU for 96127 is a whopping...... 0. Not sure what you can bill for it, maybe like 25 cents?

 

[AcronymAllergy]

The work RVU for 96127 is a whopping...... 0. Not sure what you can bill for it, maybe like 25 cents?

A site somewhere said actual reimbursement is around $5 per. And since it was on the internet, it must be true.

 

[WisNeuro]

A site somewhere said actual reimbursement is around $5 per. And since it was on the internet, it must be true.

CMS allowable charge is like $5-6, I believe. Not sure what private payors will give you.

 

[erg923]

I have seen this CPT used as an add-on code for giving 2-3 measures such as PHQ, GAD-7, OQ-45 etc., which would add a whopping $18 to the encounter (if one used all 3). I dont know if they were actually paid-out though. Strictly, I don't know that the MMSE or MOCA would count for this given the CPT code definition? It is traditionally thought such things would be an "incidental to" service of the primary code/encounter and not billed separately. I cant imagine trying to get any extra 6 dollars because I had the patient do a BDI during my 90791? But then again, I'm not in PP. Maybe you need to cover your BDI costs, but that really seems like you're milking it. I think doing 2-3 of these codes with each of your therapy sessions would probably be asking for an insurance company audit since there is there is a RCI aren't meaningful when used repetitively for weeks on end.

 

[WisNeuro]

I believe the code is 1 shot, it's not a unit code

 

[Sanman]

I have seen this CPT used as an add-on code for giving 2-3 measures such as PHQ, GAD-7, OQ-45 etc., which would add a whopping $18 to the encounter (if one used all 3). I dont know if they were actually paid-out though. Strictly, I don't know that the MMSE or MOCA would count for this given the CPT code definition? It is traditionally thought such things would be an "incidental to" service of the primary code/encounter and not billed separately. I cant imagine trying to get any extra 6 dollars because I had the patient do a BDI during by 90791? But then again, I'm not in PP. Maybe you need to cover your BDI costs, but that really seems like you're milking it. I think doing 2-3 of these codes with each of your therapy sessions would probably be asking for an insurance company audit since there is there is a RCI aren't meaningful when used repetitively for weeks on end.

Given cuts in base level reimbursement, I can imagine that it is worth adding the code it the work is done. While I don't think this needs to be added at every session. You might be able to do and bill for this monthly. Gotta make that bread somehow.

 

[erg923]

Given cuts in base level reimbursement, I can imagine that it is worth adding the code it the work is done. While I don't think this needs to be added at every session. You might be able to do and bill for this monthly. Gotta make that bread somehow.

 

[IWillSurvive]

Thanks for the info. From the reading I've done, it looks like 96127 used to count for .15 RVU credit in 2019 (and maybe more in the past) but it now counts for nothing, as someone mentioned above. I think I saw somewhere that it's like a x4/year limit or something to that effect. I was thinking of adding it on when I do intakes and when I give measures in groups but since it gets me zero RVU's, I will scratch that. For context, new psychologist...and my leadership gives me zero instruction on how many RVU's I should be aiming for. I once asked this in my initial performance eval and was told that they would have to ask someone. Needless to say, I never heard back on that and I am assuming I won't since some of the other psychologists in my clinic don't know their RVU target either. I have some low level anxiety about this and referrals have been slow because we have a lot of arbitrary and convoluted rules about how referrals get passed out... sooo I'm trying to make everything count. I have been learning how to calculate my encounters (and types) in Vista to try to gauge where I am. I don't really know how any of these numbers translate into ratings though.

 

[WisNeuro]

Aren't you in the VA? No reason to be anxious as it's nearly impossible to be fired from that position. Best thing you can do, ask these questions through e-mail, archive your encounters. Leave a paper trail. If no one can give you a number, just stay relatively busy. If they come at you a year later about RVUs, shove those e-mails in their face.

 

[cara susanna]

Thanks for the info. From the reading I've done, it looks like 96127 used to count for .15 RVU credit in 2019 (and maybe more in the past) but it now counts for nothing, as someone mentioned above. I think I saw somewhere that it's like a x4/year limit or something to that effect. I was thinking of adding it on when I do intakes and when I give measures in groups but since it gets me zero RVU's, I will scratch that. For context, new psychologist...and my leadership gives me zero instruction on how many RVU's I should be aiming for. I once asked this in my initial performance eval and was told that they would have to ask someone. Needless to say, I never heard back on that and I am assuming I won't since some of the other psychologists in my clinic don't know their RVU target either. I have some low level anxiety about this and referrals have been slow because we have a lot of arbitrary and convoluted rules about how referrals get passed out... sooo I'm trying to make everything count. I have been learning how to calculate my encounters (and types) in Vista to try to gauge where I am. I don't really know how any of these numbers translate into ratings though.

Lol, I'm at another VA clinic and I can't stop hearing about how many RVUs I should be getting as a psychologist. I would enjoy it while it lasts.

 

[IWillSurvive]

Thanks for the feedback. Yes, I probably should just be grateful and try to enjoy it while it lasts! I think I am concerned bc I was just awarded EDRP which is seriously a blessing from God. My loans will shrink fast in the next 5 years if all goes according to plan. One of the requirements for the program is being in good standing with performance evals so I am just kinda concerned for that reason...despite all the things I hear about how hard it is to get fired in the VA like WisNeuro said! They seem to be having a hard time keeping psychologists at our facility anyway so my fears are probably pretty irrational 😀 I like the recommendation about the paper trail though!