Cpt testing codes

[LadyHalcyon]

Just submitted billing with new cpt testing codes. Anyone have any problems with reimbursement? I used codes 96130, 96131, 96136, and 96137. I'm confused because it doesnt have a code for the clinical interview. Are we supposed to then bill a 90791?

---

Members don't see this ad.

 

[erg923]

Just submitted billing with new cpt testing codes. Anyone have any problems with reimbursement? I used codes 96130, 96131, 96136, and 96137. I'm confused because it doesnt have a code for the clinical interview. Are we supposed to then bill a 90791?

No changes to clinical interview code. It still 90791

 

[WisNeuro]

If it's for a behavioral/MH issue, 90791 is still the code to use, that didn't change for many psych eval situations

 

[LadyHalcyon]

Gotcha. Thanks!

 

[ClinicalABA]

Just submitted billing with new cpt testing codes. Anyone have any problems with reimbursement? I used codes 96130, 96131, 96136, and 96137. I'm confused because it doesnt have a code for the clinical interview. Are we supposed to then bill a 90791?

We have received some reimbursement testing done with the new codes (96136/37; 96132/33). Similar to others, still using 90791 for the initial interview/intake session.

 

[WisNeuro]

We have received some reimbursement testing done with the new codes (96136/37; 96132/33). Similar to others, still using 90791 for the initial interview/intake session.

As long as it's psych testing, you'll get it kicked back for some reimbursement sources if you try billing that with a medical/neurological diagnosis.

 

[ClinicalABA]

As long as it's psych testing, you'll get it kicked back for some reimbursement sources if you try billing that with a medical/neurological diagnosis.

Sorry- I'm not following what you are saying here. Do you mind clarifying, please?

 

[WisNeuro]

Sorry- I'm not following what you are saying here. Do you mind clarifying, please?

Sure, in some cases, if you are billing for a medical/neurological diagnosis, e.g., memory loss presumed to dementia, post-stroke, etc, some insurers will not cover 90791 in addition to neuropsych testing codes. They will kick it back and require the 96116 for the interview portion. YMMV depending on your regional carriers and LCD.

 

[ClinicalABA]

Sure, in some cases, if you are billing for a medical/neurological diagnosis, e.g., memory loss presumed to dementia, post-stroke, etc, some insurers will not cover 90791 in addition to neuropsych testing codes. They will kick it back and require the 96116 for the interview portion. YMMV depending on your regional carriers and LCD.

Thanks for the clarification. We haven't had that issue yet, though it's still early on with the new codes. My general impression is that the new codes give a better representation of what was done. Unfortunately, that have created some weird issues with our online scheduling/session conversions procedures (admittedly a lot of user error on my part!)

 

[deleted760483]

Ours are generally getting paid, except for one of our neuropsychologists who started getting all of lines denied. It turns out our credentialing company had him contracted as a clinical psychologist for years, and prior to the new codes I guess nobody minded?

 

[LadyHalcyon]

Didn't want to start a new thread, but does anyone know if you can bill a prolonged service add-on code and interactive complexity? I know you can't bill interactive complexity with a crisis code or with a family session, but I can't find anything saying you can't bill it with a prolonged service code for an individual session.

 

[LadyHalcyon]

That's hilarious. And also a bit disturbing.

Ours are generally getting paid, except for one of our neuropsychologists who started getting all of lines denied. It turns out our credentialing company had him contracted as a clinical psychologist for years, and prior to the new codes I guess nobody minded?

 

[singasongofjoy]

Didn't want to start a new thread, but does anyone know if you can bill a prolonged service add-on code and interactive complexity? I know you can't bill interactive complexity with a crisis code or with a family session, but I can't find anything saying you can't bill it with a prolonged service code for an individual session.

I haven't heard either way on that one; it wasn't part of our clinic's discussion when we were talking about switching codes- I am curious to know the answer.

Also I have another question for folks - if you're doing assessments (96130/96131 and 96136/96137 how are you keeping track of the time spent doing everything- how detailed are the notes that you are keeping? Just by code, or are you breaking it down like "x minutes writing report, x minutes doing feedback, etc"? Want to make sure I am tracking sufficient detail in case it's needed later (we still haven't rec'd any reimbursement from our local/regional MCOs yet with the new codes- they're a mess) but not go overboard with it. Considering I'm usually at different phases of several assessments/reports at a time. I need to develop a better system than my current sticky note system then putting the total minutes per code into the final report that goes into the medical record.

 

[deleted760483]

That's hilarious. And also a bit disturbing.

I found it hilarious, he didn't.

 

[deleted760483]

I haven't heard either way on that one; it wasn't part of our clinic's discussion when we were talking about switching codes- I am curious to know the answer.

Also I have another question for folks - if you're doing assessments (96130/96131 and 96136/96137 how are you keeping track of the time spent doing everything- how detailed are the notes that you are keeping? Just by code, or are you breaking it down like "x minutes writing report, x minutes doing feedback, etc"? Want to make sure I am tracking sufficient detail in case it's needed later (we still haven't rec'd any reimbursement from our local/regional MCOs yet with the new codes- they're a mess) but not go overboard with it. Considering I'm usually at different phases of several assessments/reports at a time. I need to develop a better system than my current sticky note system then putting the total minutes per code into the final report that goes into the medical record.

I break it down by the billing code it is feeding in to (and I use a psychometrist for some of my scoring), so the bottom of my reports looks like this:

Administration and Scoring Time: 120 minutes

Administration and Scoring Time (Technician): 25 minutes

Interpretation and Report Writing Time: 60 minutes

 

[WisNeuro]

I break it down by the billing code it is feeding in to (and I use a psychometrist for some of my scoring), so the bottom of my reports looks like this:

Administration and Scoring Time: 120 minutes

Administration and Scoring Time (Technician): 25 minutes

Interpretation and Report Writing Time: 60 minutes

If you are including tech testing and your own testing and scoring, make sure you clearly list who administered what tests. Some of the new codes require that you administer at least two measures to bill. Also, the entire WAIS counts as one measure according to CMS.

 

[deleted760483]

If you are including tech testing and your own testing and scoring, make sure you clearly list who administered what tests. Some of the new codes require that you administer at least two measures to bill. Also, the entire WAIS counts as one measure according to CMS.

That's interesting, the APA webinar I listened to with Tony Puente indicated the WAIS is considered a measure for each subtest. It doesn't matter to me as I never administer it individually, but some may.

I administer all of the tests, I just have my psychometrist score most of them. I never do fewer than 2 tests.

 

[LadyHalcyon]

That's interesting, the APA webinar I listened to with Tony Puente indicated the WAIS is considered a measure for each subtest. It doesn't matter to me as I never administer it individually, but some may.

I administer all of the tests, I just have my psychometrist score most of them. I never do fewer than 2 tests.

I don't think I billed correctly. I think I need to listen to that webinar.

 

[LadyHalcyon]

Anyone know if you can bill a prolonged service add-on code and interactive complexity to a 90837? Thought I'd give it one more shot

 

[WisNeuro]

That's interesting, the APA webinar I listened to with Tony Puente indicated the WAIS is considered a measure for each subtest. It doesn't matter to me as I never administer it individually, but some may.

I administer all of the tests, I just have my psychometrist score most of them. I never do fewer than 2 tests.

I was curious and went back. Tony clearly states that the entire WAIS or WMS still counts as just one test.

 

[deleted760483]

I was curious and went back. Tony clearly states that the entire WAIS or WMS still counts as just one test.

Maybe he changed his stance. I attended I believe the very first webinar on the new codes, and I know they had several after that.

 

[deleted760483]

Anyone know if you can bill a prolonged service add-on code and interactive complexity to a 90837? Thought I'd give it one more shot

You can bill interactive complexity with it. It adds a few dollars.

 

[WisNeuro]

Maybe he changed his stance. I attended I believe the very first webinar on the new codes, and I know they had several after that.

Perhaps, I have two saved on my computer, both have that stated where they count as one.

 

[deleted760483]

Perhaps, I have two saved on my computer, both have that stated where they count as one.

I can't think of a situation where I would ever give just a WAIS anyway but I will be vigilant about it. Thanks!

 

[WisNeuro]

I can't think of a situation where I would ever give just a WAIS anyway but I will be vigilant about it. Thanks!

Yeah, I don't think this affects many psychologists/neuropsychologists. From what I'm told, this was to prevent physicians from billing neuropsych testing codes after administering some computerized test with a prefab report, or billing after giving the MoCA/SLUMS/etc. But, could be important in the case of a provider working with a student and doing some of the testing during the evaluation and still wanting to bill for their testing/scoring time.