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Wiki Psychological Testing

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msawalker09

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Ridgeland, MS
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Can a provider bill 96131x4, 96136, 96130 and 96137x2?

There was a 30 minute clinical review, 30 minute mental exam, 30 minute personality measures (checklist), 30 minute projective measures (checklist), 30 minute WISC 5 test and 30 minute WJ4 test.
 
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What is the reason these services are being performed. It appears based on your listing the WISC5 & WJ4 tests that this IQ testing or psychoeducational testing in nature. Also, you indicated that there are 6 different activities that are going to be performed for 30 minutes each which only total 3 hours of testing:
  • clinical review= 30 minutes
  • mental exam= 30 minutes
  • personality measures= 30 minutes
  • projective measures= 30 minutes
  • WISC5= 30 minutes
  • WJ4= 30 minutes
However, your coding is for a total 6.5 hours based on the following codes and units listed in the first line of your post.
  • 961310x 1= 1 hour
  • 96131 x 4= 4 hours
  • 96136 x 1= 30 minutes
  • 96137 x 2= 1 hour
Your post prompts so many questions for me as an auditor for a commercial insurance company. From my perspective if I got this claim or prior authorization request (most commercial insurance companies require a PA for these services), I would question whether there is a covered medical or behavioral health diagnosis and how much actual time was spent on this testing since your coding is for 6.5 hours, but your narrative only reflects 3 hours of testing. This would very likely be denied as a claim or a PA request.
 
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CBLENNIE said:
What is the reason these services are being performed. It appears based on your listing the WISC5 & WJ4 tests that this IQ testing or psychoeducational testing in nature. Also, you indicated that there are 6 different activities that are going to be performed for 30 minutes each which only total 3 hours of testing:
  • clinical review= 30 minutes
  • mental exam= 30 minutes
  • personality measures= 30 minutes
  • projective measures= 30 minutes
  • WISC5= 30 minutes
  • WJ4= 30 minutes
However, your coding is for a total 6.5 hours based on the following codes and units listed in the first line of your post.
  • 961310x 1= 1 hour
  • 96131 x 4= 4 hours
  • 96136 x 1= 30 minutes
  • 96137 x 2= 1 hour
Your post prompts so many questions for me as an auditor for a commercial insurance company. From my perspective if I got this claim or prior authorization request (most commercial insurance companies require a PA for these services), I would question whether there is a covered medical or behavioral health diagnosis and how much actual time was spent on this testing since your coding is for 6.5 hours, but your narrative only reflects 3 hours of testing. This would very likely be denied as a claim or a PA request.
Click to expand...
Thank you. It’s an inquiry from a provider compliance perspective. Your response makes sense.
 
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