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Psych Coding

Vicki Posted Fri 11th of January, 2019 14:29:37 PM
We've learned that as part of this coding initiative for 2019 codes we can bill CPT 96131 (testing evaluation services- interpretation, integration, report, etc.) AGAIN to give testing results to the patient on follow up visits. It also instructs to note that it goes with prior evaluation services but is not clear on HOW to do that. Do we put a 25 modifier on the E/M code along with the 96131 or what is the correct way?
SuperCoder Answered Mon 14th of January, 2019 08:12:15 AM

Hi,

As per CPT guidelines, CPT 96131 cannot be coded separately as it is an addtional code and always coded with 96130 as a primary code.

The 2019 CPT code set adds 96130 to report the first hour of psychological testing evaluation services by a physician or other qualified healthcare professional and 96131 for each additional hour (List separately in addition to code for primary procedure). Report 96130 for evaluation of psychological testing that incorporates patient data, clinical data, and standardized test result interpretation, and includes clinical decision-making, a treatment plan and report as well as explaining the results to patient, family, and/or caregiver, and answering questions. Report 96131 for each additional hour that the provider is engaged in performing these services. Psychological tests include but are not limited to personality tests, attitude tests, IQ tests, and achievement tests.

Several other new codes have been added to report administration and/or scoring of psychological or neuropsychological tests, without the added services described in 96130. They include the following:

96136, Psychological or neuropsychological test administration and scoring by physician or other qualified healthcare professional, two or more tests, any method; first 30 minutes;

96137, ... each additional 30 minutes (List separately in addition to code for primary procedure);

96138, Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method? first 30 minutes;

96139, ... each additional 30 minutes (List separately in addition to code for primary procedure);

96146, Psychological or neuropsychological test administration, with single automated, standardized instrument via electronic platform, with automated result only.

 

Please also check the below link:

https://www.supercoder.com/coding-newsletters/my-primary-care-coding-alert/cpt-updates-use-these-2019-cpt-codes-for-primary-care-psych-tests-159356-article

https://www.supercoder.com/coding-newsletters/my-pediatric-coding-alert/mythbusters-bust-these-3-myths-to-start-the-new-year-right-159649-article

 

Thanks

Vicki Posted Mon 14th of January, 2019 09:25:20 AM
Then can we charge a 96130 AGAIN when the patient comes in for a follow up visit using an either a new patient E/M code or an established patient E/M code when provider is going over the results of the testing with the patient again? The articles we have read instructs to note that it goes with prior evaluation services but is not clear on HOW to do that. Do we put a 25 modifier on the E/M code along with the 96130 or what is the correct way?
SuperCoder Answered Tue 15th of January, 2019 08:58:22 AM

Hi,

As described earlier, in the CPT code 96130 provider administers standardized psychological tests to a patient, interprets the results, establishes a treatment plan, and prepares a report. This code covers the first hour of this service and includes discussion of results and treatment plan with the patient and family member(s) or caregiver(s), when performed.

However, as per CCI edits, Code 96130 is a column 2 code for E/M office visit (new patient/established patient), but modifier 25 is allowed in order to differentiate between the services provided. There is no need to bill the service code again when only discussing the result, as interactive feedback to the patient, family member(s) or caregiver(s) is the part of CPT code 96130.
Also, before billing make sure to provide the supportive documentation for medical necessity. It is also suggested to check the payer guidelines in order to bill CPT 96130 along with E/M services.

 

Thanks

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