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Thread: Neuropsych Testing For Inpatients

  1. #1

    Default Neuropsych Testing For Inpatients

    AAPC: Back to School
    Can I bill for neuropsych testing on the inpatient side and still charge the professional fee? The physcians have been using 96118 and 96119 however these services are often considered DRGs. My physicians want to start using 96116 and 96120. When I use modifer 26 the charges are still being denied.

    Any help would be greatly appreciated.


  2. #2
    Join Date
    Apr 2007
    Louisville, KY


    The facility fee and professional fee for the inpatient side really have nothing to do with one another. Perhaps you need to explain that to your carrier.

    96116 & 96118 represent physician (Pro fee) codes; 96119 represents a facility fee (not appropriate for IP) and I really would need to research the use of 96120. -26 Mod is inappropriate on 96120, making it unclear what appropriate use would be

    I hope this offers you some assistance.

    I would also think that unless your providers are credentialed with the payer as psychiatrists or neuro, it may be unlikely the carrier will recognize the use of these codes from them--though that's just a thought.
    Kevin B. Shields, RHIT, CPCO, CCS, CPC, COC, CCS-P, CPC-P, CPC-I

  3. #3

    Default Neuro psych Testing

    Hello Kevin,

    Thanks so much for responding. I am fairly new to Neuropsych and trying to soak up as much info as I can.

    I printed off the hospital notes on the patient I had questions about.

    The 96119 was billed by the psychometrist
    The 96118 was billed by the Neuropsychologist

    My next step will be to contact the insurance companies to see what their policy is on reimbursing non medical doctors etc.


  4. #4
    Join Date
    Apr 2007
    Louisville, KY


    With your tech, it's unlikely many payers will view him/her as having pro fees. They'll almost always include that payment in the DRG--according to their payment logic. I'm not used to seeing techs submitting "pro fees." Normally they are employees of the facility (therefore DRG bundled) or contracted (same deal).

    Your psychologist should be separately paid, but there's carrier discretion there too.

    Good luck.
    Kevin B. Shields, RHIT, CPCO, CCS, CPC, COC, CCS-P, CPC-P, CPC-I

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