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 use this code, according to a Coding FAQ answer from the American Academy of Neurology (AAN). This coding concept is also supported in the November 2006 CPT Assistant article covering the CNS Assessments and Tests codes.

Tip: You can count time your neurologist spends face-to-face with the patient, interpreting test results,  and preparing the report. Since this is a time-based code, time should be explicitly documented in the report.