Neurology & Pain Management Coding Alert

Question: Our clinical social worker performs services (under physician supervision) that are listed in  96150-96155 or 98960-98962, depending on the patient. How should we report her services, considering that she does not have her own NPI number?

California Subscriber
Answer: Your question raises several issues, so ensure you know the ins and outs of the situation.

CPT 2007 states that you cannot bill 96150-96155 (Health and behavior assessment [e.g., health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires], each 15 minutes face-to-face with the patient ...) with an E/M code for the same patient on the same day. You can, however, bill these health assessment codes on a separate day incident-to the physician's service -- if your neurologist meets all the incident-to regulations.

You can report a code from 98960-98962 (Education and training for patient self-management by a qualified, nonphysician healthcare professional using a standardized curriculum, face-to-face with the patient [could include caregiver/family] each 30 minutes ...) with an E/M service on the same day if your providers meet the incident-to requirements.

Caution: CMS does not appear to cover these services. The patient must sign an advance beneficiary notice (ABN) authorizing you to bill her for the service before Medicare will reimburse you.