Psychiatry Coding & Reimbursement Alert

Published on Wed Dec 12, 2012 PDF

NCCI bundles tests administered by psychologist and technician on same date of service.

When your psychiatrist or psychologist performs a psychological test such as the Minnesota Multiphasic Personality Inventory (MMPI), you’ll have three possible code choices for reporting the testing services. Use the guidelines that follow to select the right testing code the first time around.

Identify Who Administered the Test

When your psychiatrist or psychologist directly administers a psychological test such as MMPI, Rorschach test or Wechsler Adult Intelligence Scale (WAIS), you will report the services provided by your psychiatrist or psychologist using 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).

If the psychological test was performed by a technician and either your psychiatrist or psychologist only provided interpretations to the test administered by your technician, you will report 96102 (Psychological testing [includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, e.g., MMPI and WAIS], with qualified health care professional interpretation and report, administered by technician, per hour of technician time, face-to-face).

However, if the MMPI test was administered using a computer and your psychologist or psychiatrist only provided the interpretation for the test, you have to choose 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) to report the test performed.

Count Testing and Interp Time

When your psychiatrist or psychologist administers a psychological test, you will have to pay attention to the time spent on administration of the test and the time spent on providing interpretations to these tests.

Here’s how: Add the total time spent on both activities and report one unit of 96101 for every hour spent by the physician (or psychologist).

In the case of code 96102, be aware that only the time spent administering the test(s) (i.e. the technician’s time) that is countable. "This is why knowing who administered the test is so critical in correctly coding these services," observes Kent Moore, Senior Strategist for Physician Payment at the American Academy of Family Physicians.

Caveat: The minimum time you need for reporting one unit of 96101 or 96102 is 31 minutes. If the time spent is 30 minutes or less, you cannot report these codes as CPT® time guidelines for these codes have not been met.

Usually, the tests will take five-seven hours for administration, analysis and interpretations. If the testing extends beyond eight hours, a copy of the test reports might need to be sent to determine if extended testing was medically necessary.

If the tests have been performed over several days or if the test was performed on one day and interpretations were provided on another day, the total time spent is added up to calculate the number of units of 96101 or 96102. The last date when testing was done last should be date on the claim form.

For tests administered through the computer, you can report only one unit of 96103 regardless of the number of tests the patient has been administered or the time involved.

Example: Your psychiatrist administers the MMPI test on 9/27/12 on a patient suffering from bipolar disorder. The patient spent two hours completing the MMPI test, and your psychiatrist spent two hours with scoring and interpreting the test. He administers the WAIS test on the same patient on 9/29/12. The patient spent 90 minutes completing the WAIS test, and your psychiatrist spent another hour for the interpretations. Since your psychiatrist spent a total of four hours for the MMPI test (including administering the test and interpretations) and one hour forty minutes on the WAIS test, you will report it with six units of 96101 with the date of service being 9/29/12.

Coding Tip: When your psychiatrist or psychologist is only providing interpretations to tests administered by your technician or a computer, you will only report 96102 or 96103.

When the test is administered by your technician, you should not report 96101 for the time spent by your psychiatrist or psychologist on interpretations and only count the total time spent by the technician in calculating the total time spent to determine how many units of 96102 you should report.

Append Appropriate Modifier When Reporting Two Tests

When your psychiatrist or psychologist performs a psychological test and your technician also administers a psychological test, you cannot simply report both 96101 and 96102, because these two codes are subject to a Correct Coding Initiative (CCI) edit that does not typically allow reporting both these codes together.

However, you can override this edit if the administered tests were different and separate from one another. In such a case, you will have to append the modifier 59 (Distinct procedural service) to 96102. "A similar edit prohibits 96103 from being reported with 96101 unless an appropriate modifier (e.g. 59) is appended to 96103," notes Moore.

Reminder: If your psychiatrist or psychologist performs different tests on the same date of service, you will only report units of 96101 depending on the total time spent in performing and interpreting these tests.

Example: Your psychiatrist administers the MMPI test, and your technician administers the WAIS test on a patient suffering from ADHD. The patient spent two hours completing the MMPI test, and your psychiatrist spent two hours with scoring and interpreting the test. The patient spent 80 minutes completing the WAIS test, and your psychiatrist spent another hour for the interpretations.

You will report four units of 96101 for the time spent by your psychiatrist in administering, scoring and interpreting the MMPI, and 1 unit of 96102 (with the modifier 59 appended) for the time spent by your technician in administering the WAIS test. "The one unit of 96102 covers the first 60 minutes of the technician’s time; since the remaining 20 minutes is less than the CPT® minimum for reporting this code, you may not report a second unit," explains Moore.

Reimbursement tip: Unlike other psychiatry and psychotherapy codes, claims for psychological tests are not subject to the outpatient mental health treatment limitations under Section 1833(c) of the Act.