Wiki NEUROPSYCH MEDICARE LCD DIAGNOSIS ISSUE

[MLITE2113]

Hello all,

I am looking for some help with Neuropsych testing codes that are being denied not medically necessary by our MAC which is WPS in Michigan. The LCD doesn't state any specific DX Codes for us to use but, we keep getting denied with the CO-50 not medically necessary rejection. The LCD they refer to in the rejection is L34646.
Here is an example of what we billed and what was denied:
DX
1. G31.84
2. F06.8

CPT CODES:
96116 x 1
96136 x 1 - This is the one that denied not medically necessary based on the LCD above.
96137 x 8
96132 x 1
96133 x 2

We also are getting denials from the same MAC on MUE's for psychological testing and the 8 hour rule.
We did not conduct 8 hours of testing but it did go over 8 hours when you include analysis and report writing time.
Here is what we billed:
96116 x 1
96136 x 1
96137 x 9
96132 x 1
96133 x 2

96137 after an appeal (redetermination) was sent in they determined:


Again.... our provider did not perform more than 8 hours of testing but, more than 8 hours of total provider time was billed on the last day.

Please help!

Any help is appreciated very much!!!!!

 

[SharonCollachi]

Well, this is right from that LCD: "Typically, the neuropsychological evaluation requires 4-8 hours to perform, including administration, scoring, interpretation, report writing and interpretation to the patient and/or family. "

So they are saying not 8 hours of the patient testing, but 8 hours of all testing-related services.

 

[MLITE2113]

Thank you SharonCollachi for your response.
I do not see that statement in the LCD L34646 can you point out where you got that exactly?

Thanks again!

 

[MLITE2113]

I found it SharonCollachi--
Again thank you for your help!