Concussion Management

aclements

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Lumberton, TX
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Good Morning!

One of our departments purchased software called Impact to manage patients with concussions. The rep is providing the following codes 96116,96118, 96119,96120. As I am sure most of you do, we always research the codes before using them. I am trying to figure out what the most appropriate code to bill would be. The physician spends about an hour and a half using this software through a series of questions to manage concussions. When checking the local Medicare policy, concussion is not a diagnosis considered medically necessary and I interpret the policy as these codes are used to diagnosis the effects of a neurolgic disease caused by trauma. Not to evaluate a new trauma to see if it has effected the brain. If the concussion did not cause damage we are back to concussion which is not covered. Anyone coding for this procedure?

Thank you in advance for your assistance,
Angie :)
 

cathycoder

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We've been billing 96118 and haven't had any Medicare issues because theses patients are generally school athletes. However, we have had BCBS (TN) denials and when I looked at their medical policies regarding this, I intrepreted to say that it's only payable if performed by a neuropsychologist.

Cathy
 
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