Neurology & Pain Management Coding Alert

Question: What is functional brain mapping and how do I code for it? I’ve been in neurology coding for a few months, but just came across this service on a claim last week.

California Subscriber

Answer: You should code functional brain mapping with 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 (ie, psychologist), with review of test results and report). “In this procedure, the provider performs a series of tests involving critical brain functions like language and memory along with separately reportable functional magnetic resonance imaging (fMRI),” according to Codify by AAPC.

You’ll also likely be able to report fMRI code 70555 (Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire neurofunctional testing) with this procedure, as it is almost always performed in conjunction with functional brain mapping. Check with your provider about which fMRI they might have performed along with the brain mapping.

a

Caveat: You should not, however, report 96020 along with any of the following:

• 96112 (Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care profes­sional, with interpretation and report; first hour) through +96133 (Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; each additional hour (List separately in addition to code for primary procedure)).
• 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)
• Any evaluation and management (E/M) code.