Neurology & Pain Management Coding Alert

Report 96020 with 70555, not 70554.

You’ll have a straight shot to full reimbursement for your neurologist’s brain mapping tests if you know what component of the test your neurologist does and if another additional E/M services or psychological tests are also administered.

Focus On the Neurofunctional Test

Beginning point: The code in question is 96020 (Neurofunctional testing selection and administration during noninvasive imaging functional brain mapping, with test administered entirely by a physician or other qualified health care professional [i.e., psychologist], with review of test results and report). As the descriptor specifies, 96020 represents a testing procedure that can accurately localize critical brain areas governing speech and other functions.  “It is often performed prior to neurosurgery for severe epilepsy or brain tumors and provides a guide for the neurosurgeon to navigate safely to the tumor or other diseased area, while avoiding damage to critical areas of the brain,” says Marvel Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver, CO.

Submit 96020 for neurofunctional testing during a noninvasive imaging functional brain mapping, such as a functional magnetic resonance imaging (fMRI). The MRI records the mapping of the blood flow in the brain in response to the tests that your neurologist administers. These tests help physicians map primary brain activities related to motor, sensory and language functions. “Examples of tasks which may be used during the fMRI include sentence completion (to map language) and bilateral hand squeeze task (for sensory and motor mapping),” says Hammer.

Background: Neurologists often conduct direct cortical stimulation or somatosensory evoked potential testing during a patient’s surgery for functional mapping of the cortex or to identify critical cortical structures. A less invasive option is functional brain mapping, which the neurologist uses to determine the best treatment for neurological problems.

Do Report 96020 with 70555, But Not 70554

Your neurologist may perform the neurofunctional testing and another physician (usually a radiologist) will interpret the imaging done during the functional brain mapping. Keep these tips in mind, depending on each provider’s services:

·         Check for modifier 26: CPT^® guidelines state that you should not report 70555 (Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire neurofunctional testing) for MRI unless 96020 is also performed during the session. You would report 96020 for the neurologist’s services and the radiologist would separately report 70555. “For CPT^® codes 70555 and 96020, the technical component is not paid in the facility setting under the physician fee schedule,” says Hammer. These tests are rarely ever performed in a non-facility setting. So, your neurologist will report these services with modifier 26 (Professional component).

“The Relative Value Unit Committee (RUC) did not forward recommendations in the non-facility setting because these services are performed infrequently, if at all, in that setting (i.e., the neurologist’s office). If the test is performed in the office setting rather than a facility, the physician must negotiate with the carrier to receive appropriate reimbursement,” says Hammer.

·         Confirm if your neurologist does the entire test: You cannot report 96020 with 70554 (Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body part movement and/or visual stimulation, not requiring physician or psychologist administration).

If your neurologist does not administer the entire test represented by 96020, you should report 70554 instead. This is evident from the descriptors of the two codes: 70554 descriptor states ‘not requiring physician or psychologist administration’ while 96020 states ‘with test administered entirely by a physician or psychologist.’ The services in the two codes overlap and there isn’t any justification for reporting the two together.

“CPT^® code 70554 is inclusive of both the testing methodology and the imaging,” says Hammer. “The patient’s clinical status does not require neurofunctional testing administered by a physician or other qualified health care provider such as a psychologist during the fMRI. These tests are actually administered by a technologist or a physicist.  Since CPT code 70554 includes both the testing and the imaging, it could be considered double-billing to also report 96020.”

Don’t Report Other Psychological Tests

CPT^® code 96020 includes neuropsychological and neurobehavioral testing, as well as psychodiagnostic evaluations. Therefore, you cannot report 96020 in conjunction with codes for psychological, neuropsychological, or neurobehavioral testing during the same encounter.

The psychological and behavioral testing codes you should avoid reporting with 96020 include:

·         96101(Psychological testing [includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, e.g., MMPI, Rorschach, WAIS], per hour of the psychologist’s or physician’s time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report) -96103 – (Psychological testing [includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, e.g., MMPI], administered by a computer, with qualified health care professional interpretation and report)

·         96116-96120 for neurobehavioral status exams and neuropsychological testing.

“Medicare’s NCCI edits bundle these psychological and neuropsychological testing codes as column 2 components of 96020,” says Hammer. “The bundling edits could be bypassed with an appropriate modifier if the central nervous system tests were performed in a separate patient encounter on the same day.”

Don’t Report E/M Services On the Same Day

Evaluation and management (E/M) service codes should not be reported on the same day as 96020.

Explanation: Code 96020 represents a planned procedure scheduled ahead of time. The associated E/M care would be completed during an earlier visit instead of the day of the procedure. If you encounter a visit that includes both an E/M service and brain-mapping test on the same day, only report 96020.

Don’t Bill For Report and Review

The code descriptor for 96020 clearly states ‘with review of test results and report.’ This implies that you do not separately bill for the review and reporting services that your neurologist provides. Code 96020 is inclusive of these.