Wiki Neuro psych testing-Feedback denial and UHC

[annapadgett]

Hello. Our psychologist is billing 96133*1 on the last date of service when supplying feedback session w/ client. UHC is denying this stating it's an add-on code. UHC is the only carrier denying when we submit this way. Any advice on what we are doing wrong? See below for example of claim submitted.

03/03/2022	90791	1	$ 375.00
04/14/2022	96136	1	$ 375.00
4/14/2022	96137	9	$ 1,575.00
4/22/2022	96137	2	$ 350.00
4/22/2022	96132	1	$ 375.00
4/22/2022	96133	7	$ 2,625.00
4/28/2022	96133	1	$ 375.00 DENIED for billing add on code

Second UHC Issue: 96137 denied. Per UHC 96137 not approved for payment. I appealed as original denial indicated we exceed the frequency. Submitted appeal w/ UHC's policy stating frequency policy and proof we did not exceed. Received denial to appeal stating: we reviewed the documentation and no further payment will be made. Claims denied per benefits.

1/31/2022	90791	1	$ 375.00	PD
2/17/2022	96136	1	$ 175.00	PD
2/17/2022	96137	7	$ 1,225.00	Denied
2/24/2022	96137	4	$ 700.00	Denied
3/17/2022	96137	2	$ 350.00	Denied
3/17/2022	96132	1	$ 375.00	PD
3/17/2022	96133	8	$ 2,625.00	PD

Thank you in advance!!!!!!!!!!!!!!!

 

[mhoffman7@pennstatehealth.psu.edu]

Hi Anna, I hope you got an answer to your question here? If not, I do the billing for Neuropsych Testing. Generally all of these codes would need to be billed on the final date of service. When I send the ones out for our providers I do send the Testing codes out separately on occasion. So, I would bill the 90791 like you did first, then I would do the 96136 x 1 /96137 x13 together all units on same date of service, all on the 3/17 with the 96132 x1 and 96133 x 8 all on the 3/17. You may have to move all the charges to the 3/17 date and reimburse those for 2/17 and rebill on 3/17 and explain that you are billing together all units for final day testing on 3/17. This is how we generally have to do our billing for Neuropsych Testing. I can usually send out the Tech charges 96138/96139 by themselves on that date or the 96136/96137 together on their date and the rest separately at the latest date. Maybe this will help.

 

[klarson1104]

Hi Anna, I hope you got an answer to your question here? If not, I do the billing for Neuropsych Testing. Generally all of these codes would need to be billed on the final date of service. When I send the ones out for our providers I do send the Testing codes out separately on occasion. So, I would bill the 90791 like you did first, then I would do the 96136 x 1 /96137 x13 together all units on same date of service, all on the 3/17 with the 96132 x1 and 96133 x 8 all on the 3/17. You may have to move all the charges to the 3/17 date and reimburse those for 2/17 and rebill on 3/17 and explain that you are billing together all units for final day testing on 3/17. This is how we generally have to do our billing for Neuropsych Testing. I can usually send out the Tech charges 96138/96139 by themselves on that date or the 96136/96137 together on their date and the rest separately at the latest date. Maybe this will help.

Hello! I also work for a Neuropsych Testing Group. I am finding that 90791 is being denied due to the diagnosis code. What F Code would you use if the exam was age-related cognitive decline or a normal exam?
Thank you,
Karla