Psychiatry Coding & Reimbursement Alert

Published on Thu Nov 03, 2016 PDF

Question: Our psychiatrist is performing psychological tests for a patient. These tests were administered through a computer and interpreted by our clinician. I want to know whether or not you can report an E/M service on the same calendar date on which the psychological tests were performed?

New Jersey Subscriber

Answer: When a patient is administered psychological tests through a computer, you will have to report it with 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). Prior to performing the psychological test, your clinician will have to provide documentation that will prove the medical necessity of performing the test.

In order to prove medical necessity of performing the psychological testing, your clinician will undertake an evaluation of the patient and arrive at a probable diagnosis. In order to confirm the diagnosis, your clinician will want to perform the psychological testing. The evaluation of the patient can be reported with a suitable E/M code (such as 99203, Office or other outpatient visit for the evaluation and management of a new patient…) or with 90792 (Psychiatric diagnostic evaluation with medical services), as appropriate.

If you are reporting an E/M code for the evaluation of the patient and if this evaluation was performed on the same day on which the psychological tests were administered, you can report both the E/M code for the evaluation and 96103 for the administration of the psychological tests. However, you will face edits from Correct Coding Initiative (CCI) if you try reporting 96103 with an E/M code.

Since the modifier indicator to the edit bundle is ‘1,’ you can overcome the edit if you append a suitable modifier. Since 96103 is the column 2 code in the edit bundle with E/M codes, you will have to append the modifier to the psychological testing code. The modifier that you will append to 96103 is 59 (Distinct procedural service).

Note: There is no edit bundling between 96103 and the initial psychodiagnostic evaluation code, 90792. So, if you are reporting 96103 on the same calendar date on which you are reporting 90792, you can report both the codes together without using any modifiers.