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Marilyn Posted Fri 27th of December, 2013 08:42:59 AM

When billing for 96101 and 96102 same day, where and which modifier to use?

SuperCoder Answered Fri 27th of December, 2013 18:09:14 PM

Append Appropriate Modifier When Reporting Two Tests

When your psychiatrist or psychologist performs a psychological test and your technician also administers a psychological test, you cannot simply report both 96101 and 96102, because these two codes are subject to a Correct Coding Initiative (CCI) edit that does not typically allow reporting both these codes together.

However, you can override this edit if the administered tests were different and separate from one another. In such a case, you will have to append the modifier 59 (Distinct procedural service) to 96102. "A similar edit prohibits 96103 from being reported with 96101 unless an appropriate modifier (e.g. 59) is appended to 96103," notes Moore.

Reminder: If your psychiatrist or psychologist performs different tests on the same date of service, you will only report units of 96101 depending on the total time spent in performing and interpreting these tests.

Example: Your psychiatrist administers the MMPI test, and your technician administers the WAIS test on a patient suffering from ADHD. The patient spent two hours completing the MMPI test, and your psychiatrist spent two hours with scoring and interpreting the test. The patient spent 80 minutes completing the WAIS test, and your psychiatrist spent another hour for the interpretations.

You will report four units of 96101 for the time spent by your psychiatrist in administering, scoring and interpreting the MMPI, and 1 unit of 96102 (with the modifier 59 appended) for the time spent by your technician in administering the WAIS test. "The one unit of 96102 covers the first 60 minutes of the technician’s time; since the remaining 20 minutes is less than the CPT® minimum for reporting this code, you may not report a second unit," explains Moore.

Reimbursement tip: Unlike other psychiatry and psychotherapy codes, claims for psychological tests are not subject to the outpatient mental health treatment limitations under Section 1833(c) of the Act.

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