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Pearson Testing Billing

  1. Exclamation Pearson Testing Billing
    Medical Coding Books
    Our office has started performing Pearson testing on patients as an assessment before getting scheduled for neurostimulator trials.

    For those of you who aren't familiar w/ Pearson testing it is basically a form that the patient fills out, the answers get faxed out, someone offsite intereprets the results and these get faxed back to us which will inform us of whether or not the patient is psychologically "fit" to get the neurostimulator procedure.

    The patients are filling out these "paper & pen" questionnaires while in office with a medical assistant administering the test. The provider is NOT in the room with this time.

    What, if anything, is billable?

    We were originally told that 96101 would be billable no matter who administers the test but upon further research on my part I don't feel comfortable coding this as the physician didn't administer the test directly nor are we interpreting the test.

    Any help would be greatly appreciated.

  2. Default Pearson testing
    96102, 96103/92119,96120 are the codes for tests administered by a technician-per hour. Here are billing examples from CMS regarding what can be billed based on provider/testing and integration of the test results.

    Can more than one CPT code for psychological or neuropsychological testing be billed together on the same date of service for the same patient if all of the testing is administered by a technician and/or computer?
    Yes. The technician-administered code (96102/96119) is billed based on the number of hours that the technician spends face-to-face with the patient. The computer-administered testing code (96103/96120) is billed once regardless of the time spent completing the tests. Note, however, that when testing is administered by a technician or a computer, the time that the physician/psychologist spends interpreting and reporting the results of each individual test is already included in each of these codes.
    Here is the CMS link to the top 8 questions and answers for billing this type of testing. (if the answers don't come up quickly, just type neuropsychological into the page search box and hit search)

    Last edited by MMAYCOCK; 07-23-2011 at 07:54 AM. Reason: additonal option

  3. #3
    Denver Colorado
    Also check out the revised CPT section guidelines for these codes -
    ...A minimum of 31 minutes must be provided to report any per hour code...

    The time basis for 96102 is face-to-face time with the technician. Often these types of tests take far less than 31 minutes of face-to-face time for the technician to administer. If so you would need to append modifier 52 to the code. Plus remember that documentation for all time based codes should include the TIME spent performing the service. Also another often overlooked item!

  4. #4
    St. Joseph County, Indiana
    Coding issues aside, I have never recommended pain physicians use these tests for spinal cord stimulator trial patients. My main reason is that since it is difficult at best for trained psychological professionals to accurately determine the "fitness" of patients for stimulator placements, I do not know how a pain physician with little or no psyche training can give a reasonable opinion. I work with several clinics who have performed a combined 150 stim trials a year. I come across two or three psyche eval's a month from psyche specialists where the psychiatrist or psychologist really struggles with the patients appropriateness for the stim trial.

    I guess I may be exaggerating the problem since these technician administered eval's must be paying pre-determinations and pre-certs, right?


    Brock Berta

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