Wiki Neuro/Psych Test

[Amcilwain]

I have a practice that hired a locum psychiatrist. They are wanting to bill out a 99215, 96138 and 96132 all together for ADHD patients. I don't have a lot of experience and need help finding more resources on the subject. I am under the impresion that the 99215 should not be billed with these codes. Any Help is appreciated.

 

[Maria1994]

In some cases, you are able to report an E/M with mod 25 in addition to those neuropsych codes. This article might be helpful. It lists example cases as well. https://creyos.com/blog/cpt-code-96...25: Used to indicate,threshold of 31+ minutes).

 

[jkyles]

As noted above it might be possible to unbundle the E/M service but it must meet the requirements for modifier 25. What raises a red flag for me is this statement: "They are wanting to bill out a 99215, 96138 and 96132 all together for ADHD patients."

They can of course report a level 5 when appropriate, but automatically billing a level 5 based on the diagnosis is going to expose your practice to audit risk. (In fact, any sort of language that indicates the provider intends to "always" bill a certain way warrants a closer look.)