Neurology & Pain Management Coding Alert

Question: A neurologist performed a neurobehavior exam that lasted 44 minutes. How should I code for this CNS test? Do I need modifier 52 since the exam lasted less than one hour? New York Subscriber Answer: You should report 96116 (Neurobehavioral status exam [clinical assessment of thinking, reasoning and judgment, e.g., acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities], per hour of the psychologist's or physician's time, both face-to-face time with the patient and time interpreting test results and preparing the report). You do not need to append modifier 52 (Reduced service) to 96116 just because your neurologist spent less than one hour on the exam. The code descriptor states "per hour" but if the total time spent on the diagnostic study exceeds the "half-way threshold" -- in other words, if your neurologist spent at least 31 minutes or more on the service -- you can still [...]