Psychiatry Coding & Reimbursement Alert

Published on Tue Apr 05, 2016 PDF

Hint: Watch CCI edits when reporting multiple tests together.

When a patient is administered psychological testing through a computer, you need to concentrate on your psychiatrist’s (or technician’s) involvement in the process. You also need to check on what other tests were administered on the same calendar date of service.

Choose an Appropriate Code to Report Based on Provider

The psychological tests might be administered by your psychiatrist (or psychologist), your technician, or a computer. Based on who is administering the tests, you will have to report one of the following codes:

• 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)
• 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)
• 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).

Heads up: Since psychological tests reported with CPT^® codes 96101 and 96102 were covered in the previous issue of the Psychiatry Coding and Reimbursement Alert, we will be focusing more on computer administered psychological testing reported with 96103 in this issue.

Code 96103 should be reserved for situations where the computer administered testing is not aided by your clinician or a technician other than for the installation of programs or tests and checking to ensure the patient is able to comprehend and complete the tests. If greater levels of interaction are required, though the test may be computer-based, then you should use the physician administered code (96101) or the technician code (96102).

Unlike 96101 and 96102, which are “time based” codes that you may report multiple times depending on the number of hours required to administer and, in the case of 96101, interpret and report on the tests, 96103 is not a time based code. So, you will only be able to report this code once per session on a calendar date of service, irrespective of the time spent administering the testing with the patient on that day of service.

Check if Interpretation of Computerized Testing Should Be Reported Separately

For tests administered through a computer, your clinician or some other qualified health care professional will be interpreting the results of the tests and preparing a report. So, when reporting computerized psychological testing with 96103, you are likely to wonder if you need to report this interpretation and preparation of the reports separately with another CPT^® code, such as 96101.

But, you need to remember that you cannot report the interpretation and preparation of reports separately. When you see the descriptor to 96103, you will notice that it contains the phrase “with qualified health care professional interpretation and report.” The inclusion of this phrase in the descriptor indicates that the work component of interpretation provided by your psychiatrist or any other qualified health care professional who can provide the interpretation to these tests and report preparation is included in the relative value units assigned to 96103. For this reason, you are not allowed to report the interpretation and report preparation separately. “CPT^® reinforces this point with a parenthetical after the descriptor for 96101. That parenthetical states, ‘Do not report 96101 for the interpretation and report of 96102, 96103’,” observes Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

Watch CCI When Reporting Different Provider Tests

You might be assuming that you cannot report psychological tests provided by different providers together. You might end up losing deserved pay if you fail to see when and how you can report tests administered by different providers.

When the tests administered by the computer and the one administered by your psychiatrist are the same, report the code only for one test. If you report the CPT^® codes 96103 and 96101 for the same test, you will not be paid for both if the payer is following Correct Coding Initiative (CCI) edits.

According to CCI edits, you will face bundling if you report 96103 with 96101 (or 96102). So, when your clinician is repeating the same test that was administered through the computer, report only the test that your clinician performs,because 96101 is the column 1 code in the edit with 96103. If your clinician is only interpreting the test administered through the computer, report only 96103.

However, if your psychiatrist (or technician) administers a test(s) that is completely different from the tests administered through the computer, you can report both these tests separately. As the modifier indicator to the CCI edit is 1, you can break the edit by using a suitable modifier in such an instance. The modifier that you will use is 59 (Distinct procedural service). You will have to append the modifier to 96103 as this is the column 2 code in the edit with 96101 (and 96102).

Remember: Provide sufficient documentation to the payer to let them know that the tests that were performed by your clinician (or technician) were different from the test that was computer administered, so there is no denial for the claim.

Know if Same Day E/M Codes Be Reported With 96103

If your clinician performs an E/M service on the same day on which the patient is administered psychological tests through the computer, you will need to know if you can report the E/M service in addition to reporting 96103. Note that you will face bundling edits if you try reporting an E/M code and 96103 on the same calendar date of service.

This edit bundle between E/M codes and 96103 carries a modifier indicator of ‘1,’ which means you can unbundle the codes by using a suitable modifier. As 96103 is the column 2 code in the edit bundle with E/M codes, you can report both the codes on the same calendar date of service by appending a modifier to 96103. The modifier that you will use with 96103 is 59.