Question regarding CPT coding for PP Testing

[dynamicdog]

Advertisement - Members don't see this ad

Hello all. I am trying to navigate CPT coding waters for testing. 96101 is the code per unit for "psychological testing," 96118 is the code per unit for "neuropsychological testing," and 96111 is "developmental testing, extended". I conduct very extensive batteries that can arguably fall into any of these categories.
I'm curious if people in PP or otherwise have any knowledge or experience with this they can speak to.

Thanks!

 

[WisNeuro]

Depends, are you credentialed with both the medical and behavioral health side of the insurance you are billing for said service? Also, depends on the referral question and what you are doing the evaluation for.

 

[dynamicdog]

I am only contracted through the behavioral health side. When/why would a clinical psychologist be contracted medically in PP? And how would that effect the coding?

 

[WisNeuro]

I am only contracted through the behavioral health side. When/why would a clinical psychologist be contracted medically in PP? And how would that effect the coding?

It affects coding when I am evaluating medical conditions vs behavioral health conditions, and whether or not I can bill for them in the first place. For a recent example on the medical side, cognitive sequelae of CADASIL.

 

[dynamicdog]

It affects coding when I am evaluating medical conditions vs behavioral health conditions, and whether or not I can bill for them in the first place. For a recent example on the medical side, cognitive sequelae of CADASIL.

That makes sense. Thanks for your input!

 

[erg923]

Hello all. I am trying to navigate CPT coding waters for testing. 96101 is the code per unit for "psychological testing," 96118 is the code per unit for "neuropsychological testing," and 96111 is "developmental testing, extended". I conduct very extensive batteries that can arguably fall into any of these categories.
I'm curious if people in PP or otherwise have any knowledge or experience with this they can speak to.

Thanks!

I dont think there is any sense in mixing the codes. You'll just confuse someone at the insurance company. Look up Puentes coding advice stuff.

 

[WisNeuro]

Definitely don't mix the codes if you want to actually get reimbursed. Figure out what kind of eval you are actually doing, and bill for that. Erg is right, Puente has a few great powerpoints that go over this. Unfortunately, they are changing all of our codes this year and starting in 2019, we'll have a brand new set to work from, which will be much more complicated and require a lot more documentation about services.

 

[dynamicdog]

I dont think there is any sense in mixing the codes. You'll just confuse someone at the insurance company. Look up Puentes coding advice stuff.

Thank you for the Puente code info. I wasn't planning on mixing codes, but curious as to when someone would code for one versus another. I've been searching through available information and haven't seen too much on this so was hoping to hear from others who have used these codes, and in what contexts.