Neurostimulation Eval Reimbursements

[InterventionMD45]

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Recently started a psychiatry division within our large pain/neurosurgery group because we couldn't get any of our cases scheduled/seen for surgical clearance. Can anyone provide some guidance on coding for Neuromodulation/Spinal Cord Stimulation clearances? Currently using 96101

 

[Sushirolls]

What are the EOB statements saying for denials? When you call the insurance companies, what are they saying they want or why they are not paying for these consults?

 

[WisNeuro]

Hmm, one reason that 96101 may be getting denied is that it doesn't exist anymore. It was replaced start of the year.

 

[erg923]

Currently using 96101

No longer exists.

 

[InterventionMD45]

Are you a psychiatrist or psychologist? 96101 is a psychological testing code, typically requires prior authorization from insurance companies, and while psychiatrists can use it, imho it is not worth our time and it is almost never appropriate to do so. Insurance companies typically want you to use 90792. If I am doing consults for pre-operative psychiatric evaluation (there is no such a thing as psychiatric "clearance"), then I will either use 99245 (consult code - only reimbursable by certain PPO plans), or I request that the surgeons pay me directly and bundle it into the cost of the procedure.

Typically a good pain psychologist is going to be cheaper and better placed to do evaluations for spinal cord stimulators.

Thanks for the feedback on coding - much appreciated

 

[InterventionMD45]

Hmm, one reason that 96101 may be getting denied is that it doesn't exist anymore. It was replaced start of the year.

Welp...that would certainly explain it. Time to hire billing consultant?

 

[WisNeuro]

Welp...that would certainly explain it. Time to hire billing consultant?

Probably wouldn't hurt, at least temporarily as things get off the ground. There are a ton of ways that billing and time can be optimized that people miss. Especially within the testing and evaluation codes.