New Testing Codes-2019

[erg923]

https://www.apapracticecentral.org/reimbursement/testing-codes/neuropsychological-testing.pdf

https://www.apapracticecentral.org/reimbursement/testing-codes/psychological-testing.pdf


Discuss. Seems unnecessarily complex to me, but Idk.

And what do they mean "Evaluation services must always be performed by the professional prior to test administration." How does one engage in "interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report and interactive feedback to the patient, family member(s) or caregiver(s), when performed" prior to before doing any testing?!

---

Members don't see this ad.

 

[WisNeuro]

https://www.apapracticecentral.org/reimbursement/testing-codes/neuropsychological-testing.pdf

https://www.apapracticecentral.org/reimbursement/testing-codes/psychological-testing.pdf


Discuss. Seems unnecessarily complex to me, but Idk.

And what do they mean "Evaluation services must always be performed by the professional prior to test administration." How does one engage in "interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report and interactive feedback to the patient, family member(s) or caregiver(s), when performed" prior to before doing any testing?!

Yeah, it's about to be a clusterf*ck. We're still awaiting clarification on a few things, but so far the interpretation is that you need some kind of eval (e.g., old 96116 code) that determines that testing is necessary to answer a certain referral question. Rather than just going right into test administration. Namely, you have to documentation that you determined that the assessment was needed.

 

[Pragma]

https://www.apapracticecentral.org/reimbursement/testing-codes/neuropsychological-testing.pdf

https://www.apapracticecentral.org/reimbursement/testing-codes/psychological-testing.pdf


Discuss. Seems unnecessarily complex to me, but Idk.

And what do they mean "Evaluation services must always be performed by the professional prior to test administration." How does one engage in "interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report and interactive feedback to the patient, family member(s) or caregiver(s), when performed" prior to before doing any testing?!

I think they want one code to cover most of the process. I’d assume an interview code is what they mean before using testing codes? Will have to review more later.

 

[WisNeuro]

From what I'm hearing on reimbursement, if you are used to billing long hours of evals (>3 hours of testing) then get ready to lose money. Word is that the add on codes for the "each additional hour" category will drop off considerably. Doing more evals, at fewer hours will be what pays off now.

 

[erg923]

Yeah, it's about to be a clusterf*ck. We're still awaiting clarification on a few things, but so far the interpretation is that you need some kind of eval (e.g., old 96116 code) that determines that testing is necessary to answer a certain referral question. Rather than just going right into test administration. Namely, you have to documentation that you determined that the assessment was needed.

Oh, so they meant doing a 90791 or 96116 before testing, not the new 98130 96132? Well, that actually seems pretty reasonable to me. Don't you want to see a patient first before picking your battery so you know what they need?

 

[WisNeuro]

Oh, so they meant doing a 90791 or 96116 before testing, not the new 98130 96132? Well, that actually seems pretty reasonable to me. Don't you want to see a patient first before picking your battery so you know what they need?

Yeah, I agree with it, if that is indeed the case. I always interview before doing any testing, but that's not always the case with some providers.

 

[erg923]

Yeah, I agree with it, if that is indeed the case. I always interview before doing any testing, but that's not always the case with some providers.

The HRB people, Im guess you mean?

 

[WisNeuro]

The HRB people, Im guess you mean?

Mostly, some fixed battery peeps will just have their testers do the battery and interview later. Complete waste of time for people who basement out on things. For example, when it is clear that someone is much more impaired than I originally thought, I may check down to an RBANS plus type battery, which will lead to a reduction in billing time.

 

[erg923]

Mostly, some fixed battery peeps will just have their testers do the battery and interview later. Complete waste of time for people who basement out on things. For example, when it is clear that someone is much more impaired than I originally thought, I may check down to an RBANS plus type battery, which will lead to a reduction in billing time.

What do you think of the new codes? Seems like it will take longer to bill and fill out things? What wasnt working with the old codes, if anything?

 

[WisNeuro]

What do you think of the new codes? Seems like it will take longer to bill and fill out things? What wasnt working with the old codes, if anything?

It'll just add some time to how we document billing. Not too much, really, for those of us using EMRs like EPIC. We can just template it up and quickly change the hours for each code. CMS just determined that the old codes were high usage, and thus needed revisions. So, they chose to incentivize shorter testing, and possibly the use of psychometrists who are cheaper (generally). They also wanted to break out test admin time (which they will reimburse **** for now) and other elements (e.g., interpretation, report writing).

 

[Therapist4Chnge]

Ugh...what a hassle.

Commercial insurance sure isn’t going to pay better, nor will gov’t insurances, but we’ve known that for 20yrs. I gave up on those awhile ago, but I worry about how these changes will likely trickle down and impact other areas like workers comp evals, psychoeducational evals, maybe cashpay assessments, etc.

 

[erg923]

Like no neuropsychs in my area even take insurance.

Most neuropsychology practices are entirely insurance dependent though.

 

[WisNeuro]

Like no neuropsychs in my area even take insurance.

Do you have any hospitals or AMCs in your area? Because they definitely take insurance.

 

[erg923]

thats gotta be a typo, right:


Evaluation services must always be performed by the professional prior to test administration, and may be billed on the same or different days.

We had the discussion earlier in the thread. Take a look. The thinking is they meant either a 90791 or a 96116 prior to testing.

 

[WisNeuro]

So wait, this is a typical eval structure for me:

I am so confused. Why put the 96130 and 96131 codes before the 96136 and 96137 codes.

Because they are for billing different parts of the evaluation.

 

[Therapist4Chnge]

We had the discussion earlier in the thread. Take a look. The thinking is they meant either a 90791 or a 96116 prior to testing.

That has been the case already...? I guess i’ve seen testing and then interviews (as mentioned above), but testing w/o any intake is...weird.

I really hope clinicians doing neuro/health/pain/etc. push back where they can. If I get squeezed, I go back to the provider and tell them to narrow their referral bc I can only adequately cover part of what they want in the “approved” time. It is surprisingly effective. If I can’t get a more narrow referral, I decline the referral. There can be fallout, but there is plenty of work out there and I decided years ago i’d rather see less patients than accept crap reimbursements. Most providers are understanding when I tell/told them the %-discount i’d have to absorb. YMMV, as I know some providers are perfectly fine with being devalued and taking peanuts for their work.

 

[AcronymAllergy]

I'm potentially confusing myself and/or parsing hairs, but are they essentially saying that you should bill for both the interview (e.g., 96116) and some amount of evaluation prior to doing any testing? Inherently it makes sense in that you're going to be conducting "neuropsychological evaluation" on interview data and records review to inform your testing choices, but I'd figured much of that would be incorporated in 96116. Although maybe not and/or it hinges on including the records review.

In the end, though, if all of the coding/billing is for the same day and submitted in one big chunk, it may not matter...?

Looks like I need to start doing a better job of tracking how much time I spend scoring vs. reviewing and writing.

 

[erg923]

Looks like I need to start doing a better job of tracking how much time I spend scoring vs. reviewing and writing.

Exactly. It's taking a inclusive and relatively straightforward coding/billing process (sans the clinical interview session-90791 or 96116) and made it inordinately cumbersome (from both a provider and payer standpoint), from what I can tell/predict at least?

I work in managed care, not doing UM/UR mind you, and we new nothing about this until last month. Not sure how this shakes out within the industry or with providers? Again, another example of psychology services being an after thought within the managed care and larger healthcare industry. And we wonder how we got here?

Maybe we should spend more time arguing about whose board is better, how may post doc hours states should require for licensure in psychology, how many more exams we need to take to get licensed, etc. That should help whilst Rome burns...

 

[WisNeuro]

I actually understand the breaking test administration apart from the interpretation/report writing elements and such.

Maybe we should spend more time arguing about whose board is better, how may post doc hours states should require for licensure in psychology, how many more exams we need to take to get licensed, etc. That should help whilst Rome burns...

We don't have much of a say in the matter until the initial proposed guidelines come out for comment. And then APAPO actually stopped a pretty steep proposed cut in the assessment codes. Word is that CMS originally wanted like a 30% cut in reimbursement.

Also, the issue of which board is better has pretty much been decided

 

[erg923]

I actually understand the breaking test administration apart from the interpretation/report writing elements and such.



We don't have much of a say in the matter until the initial proposed guidelines come out for comment. And then APAPO actually stopped a pretty steep proposed cut in the assessment codes. Word is that CMS originally wanted like a 30% cut in reimbursement.

Also, the issue of which board is better has pretty much been decided

Fair enough. All I know is that I work in a system doing stuff a blend of pop health and clinical management/advising that I generally like, but it pretty blind to larger psychology services and is dominated by medicine/medical model. Our profession, other than psychotherapy, is generally and afterthought.

 

[WisNeuro]

Fair enough. All I know is that I work in a system doing stuff a blend of pop health and clinical management/advising that I generally like, but it pretty blind to larger psychology services and is dominated by medicine/medical model. Our profession, other than psychotherapy, is generally and afterthought.

With how much we've dumbed down our training and the proliferation, I'm not too surprised.

 

[ClinicalABA]

We had the discussion earlier in the thread. Take a look. The thinking is they meant either a 90791 or a 96116 prior to testing.

I’m typically billing 1 hour of 90791 for the first contact. I use this session to determine what, if any, tests I’m going to do and then request an auth for 96118 (3+ hours) and one hour of 90847 for feedback and planning. Curious as to how new codes will pan out.

 

[WisNeuro]

I’m typically billing 1 hour of 90791 for the first contact. I use this session to determine what, if any, tests I’m going to do and then request an auth for 96118 (3+ hours) and one hour of 90847 for feedback and planning. Curious as to how new codes will pan out.

In many places, the use of 90791 depends on if you are credentialed on behavioral/medical and or what diagnosis you are using. There are crosswalks for the new interview codes for the interview codes for psych and neuropsych interviews, 90791 is staying as far as I knew, don't know if they'll tighten up what gets used where, though.