Wiki Neuropsych Testing

[pegjoh5746]

My provider is seeing patients for testing on one date of service 96132/96133/96138/96139. A few weeks later the patient sometimes needs to come back in with family to discuss the results. He wants to bill 96133 for the subsequent visit, however this hits an edit for missing primary CPT. Is anyone having luck getting 96133 paid for a subsequent visit? Or have you had any luck changing it to 96132?

 

[dguerin]

For the follow-up, we use 90837/90847.

 

[jackiemur]

Have you gotten payment from Medicare on the 96132? The clinic I work for has not received payment on any of the medicare claims with 96132 on it. Looking for any input. The denial reason is :

PR 172: Payment is adjusted when performed/billed by a provider of this specialty​

any suggestions? the clinic is located in J5B MAC

 

[sxp003]

For the follow-up, we use 90837/90847.

My provider is seeing patients for testing on one date of service 96132/96133/96138/96139. A few weeks later the patient sometimes needs to come back in with family to discuss the results. He wants to bill 96133 for the subsequent visit, however this hits an edit for missing primary CPT. Is anyone having luck getting 96133 paid for a subsequent visit? Or have you had any luck changing it to 96132?

What cpt do we use if patient comes back alone with no family to discuss results. What cpt do you use then?

 

[brilynn.bevan@gmail.com]

I am having the same issue, no pay for different DOS I have tried both 96132 and 96133 with no avail! any info would be appreciated!

 

[SharonCollachi]

Have you gotten payment from Medicare on the 96132? The clinic I work for has not received payment on any of the medicare claims with 96132 on it. Looking for any input. The denial reason is :

PR 172: Payment is adjusted when performed/billed by a provider of this specialty​

any suggestions? the clinic is located in J5B MAC

What cpt do we use if patient comes back alone with no family to discuss results. What cpt do you use then?

I think the confusion here is that the testing codes include "... and interactive feedback to the patient, family member(s), or caregivers(s), when performed..."

You can read that two ways: one, the feedback is done the same day and included in the 96132/96133, or, two, the feedback is done on another day but nothing is billed because it was already included in the first day. Either way, you cannot bill a testing code on a day in which no testing was done. I would be inclined to use the individual psychotherapy codes for the followup discussion visit, whether or not family was present (if one person is testing, then the likelihood is the focus is on one person, even if parents or other family is also present).

In my experience, when PR172 is used in conjunction with psych testing, a provider is either considered not qualified to do psychological testing (for many insurances, only licensed clinical psychologists are paid for psych testing), or the specialty of the provider is incorrect in the insurance company's database. I once worked for a psychiatrist (MD) who was a bit, shall we say, LIVID, that some insurances considered him not qualified to do psychological testing, but they would happily pay a "lowly PhD" to do it.

To complicate matters further, in some cases, psychologists who are NOT clinical psychologists may do psych testing only if an MD orders the test. In that case, the ordering/referring MD name and NPI must be on the claim form.

When checking benefits, and determining if psych testing needs an authorization, always find out if psych testing is limited to certain providers. Back in the day, I kept a spreadsheet of this information that covered our local plans.