# Psychological Pain Evaluation?



## kseeg23 (Oct 1, 2013)

I'm wondering if anyone out there is billing for psychological pain evaluations? The Dr. came to me today saying there is a billable CPT code for when the Dr does a psychological pain evaluation/assessment. We have never done them in the office but apparently it's something he wants to start doing. I am clueless on the subject  so any information would be appreciated!!! Thanks!


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## Prabhu.A CPC (Oct 2, 2013)

*Tesa (micro tesicular extraction of sperm)*

Any one please advise cpt for TESA procedure, can i follow 55899? (Micro testicular extraction of sperm aspiration)


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## dwaldman (Oct 2, 2013)

Kseeg23,  I have never billed for this type of testing so I am not familiar with the CPT code used for a psychological pain evaluation. Can you provide the CPT codes that would be used for this. Then maybe additional information could be found regarding it.


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## kseeg23 (Oct 2, 2013)

dwaldman, I have no idea what CPT codes would be billed. I literally know nothing ha! I googled psychological pain eval online and I guess it's something a lot of pain practices offer, but I couldn't find any information as far as what CPT code was billed and what was required to even bill the code. I don't know if it's like a 45 min counseling like session or a 5 page questionaire the patient fills out, etc...I'm at a loss.


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## marvelh (Oct 2, 2013)

Review CPT codes 96101-96103 Psychological Testing


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## dwaldman (Oct 2, 2013)

Now that the code range has been provided, here is some info I could pull from WPS Medicare J5 local coverage determination policy for psychological testing per the CPT codes provided. I would recommend reviewing the LCD in your area for Medicare and medical policy for the private payers that you bill. There limitations to coverage might bring more insight to the availability of being able institute the service at your practice. There was not a lot thru the AMA but I provided what they had.....

96101 PSYCHOLOGICAL TESTING (INCLUDES PSYCHODIAGNOSTIC ASSESSMENT OF EMOTIONALITY, INTELLECTUAL ABILITIES, PERSONALITY AND PSYCHOPATHOLOGY, EG, MMPI, RORSCHACH, WAIS), PER HOUR OF THE PSYCHOLOGIST'S OR PHYSICIAN'S TIME, BOTH FACE-TO-FACE TIME ADMINISTERING TESTS TO THE PATIENT AND TIME INTERPRETING THESE TEST RESULTS AND PREPARING THE REPORT 

96102 PSYCHOLOGICAL TESTING (INCLUDES PSYCHODIAGNOSTIC ASSESSMENT OF EMOTIONALITY, INTELLECTUAL ABILITIES, PERSONALITY AND PSYCHOPATHOLOGY, EG, MMPI AND WAIS), WITH QUALIFIED HEALTH CARE PROFESSIONAL INTERPRETATION AND REPORT, ADMINISTERED BY TECHNICIAN, PER HOUR OF TECHNICIAN TIME, FACE-TO-FACE 

96103 PSYCHOLOGICAL TESTING (INCLUDES PSYCHODIAGNOSTIC ASSESSMENT OF EMOTIONALITY, INTELLECTUAL ABILITIES, PERSONALITY AND PSYCHOPATHOLOGY, EG, MMPI), ADMINISTERED  




Indications and Limitations of Coverage and/or Medical Necessity
Psychological testing
CPT codes 96101, 96102, 96103, 96105, 96111
Psychological tests are used to assess a variety of mental abilities and attributes, including Central Nervous System (CNS) Assessments such as neuro-cognitive, mental status, achievement and ability, personality, and neurological functioning.

Psychological testing requires a clinically trained examiner. All psychological tests should be administered, scored, and interpreted by a trained professional such as a clinical psychologist, psychologist, advanced nurse practitioner with education in this area or a physician assistant who works with a psychiatrist with expertise in the appropriate area. The purpose of psychological testing includes the following:

1. To assist with diagnosis and management following clinical evaluation when a mental illness or psychological abnormality is suspected. 
2. To provide a differential diagnosis from a range of neurological/psychological disorders that present with similar constellations of symptoms, e.g., differentiation between pseudodementia and depression. 
3. To determine the clinical and functional significance of a brain abnormality.
4. To delineate the specific cognitive basis of functional complaints.


____________________________________________________________________
AMA CPT Changes 2008


96101 Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, eg, MMPI, Rorschach, WAIS), per hour of the psychologists or physicians time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report

(96101 is also used in those circumstances when additional time is necessary to integrate other sources of clinical data, including previously completed and reported technician- and computer-administered tests)New or Revised Text

(Do not report 96101 for the interpretation and report of 96102, 96103)New or Revised Text

Rationale

Code 96101 was revised and two parenthetical instructions were added to the code to clarify and differentiate appropriate reporting for the services of the psychologist or physician from those testing services performed by the technician or computer-administered tests (96102 and 96103). The revisions emphasize that the services reported with this time-based code are reported appropriately for the physician or psychologist administration of the test to the patient, interpretation of the results, report preparation, and any additional necessary time for integration of the test data acquired from the computer or technician testing or other data into the report. As indicated in the exclusionary parenthetical note, code 96101 should not be reported for interpretation or report of tests administered via technician or computer.

AMA CPT Assistant September 2010 page 9

Medicine: Health and behavior Assessment/Intervention, 96101, 96118 (Q&A) 

Question: How do I code for psychological and neuropsychological testing feedback? 

Answer: Information derived from psychological and neuropsychological testing is often provided to the patient and other individuals as authorized by the patient. This information includes the results of the evaluation, potential intervention options, and referrals. Time spent providing that feedback as well as receiving any response to that information provided by the patient and/or authorized individuals is coded, using the appropriate number of billing units, with the CPT code for the testing; code 96101 (for psychological testing) or code 96118 (for neuropsychological testing). However, only communication regarding the testing results and feedback would be coded in this manner; assessment and management of other aspects of the patient's care would be coded using other appropriate CPT coding. 

AMA CPT Assistant 2011

These guidelines direct the user that "A minimum of 31 minutes must be provided to report any per hour code. Services 96101, 96116, 96118, and 96125 report time as face-to-face time with the patient and the time spent interpreting and preparing the report. (CPT 2012, p 502)"


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## atheri992 (Oct 4, 2013)

*Psychological Pain*

I code for the pain center at my hospital and our Dr. uses CPT's 90792 or 90791 for Psych Diagnostic Evals w/ one including medical services.  The other ones she used primarily were 90833, 90836, 90838, 90832, 90834, 90837, and 90785 all being time-based.   She also combines E&M services also when applicable.


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## KMCFADYEN (Oct 7, 2013)

The pain management offices I code for send patient to outside Psychiatrist or Psychologist for the Psych eval.


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## kseeg23 (Oct 9, 2013)

*Thanks*

Thanks for all your help!!


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## kseeg23 (Oct 9, 2013)

So what exactly does the psych evaluation entail? The Dr asks questions? They patient fills out a questionaire? I'm clueless so any insight would be helpful


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## SCCL5558 (Nov 4, 2013)

My Pain Management offices use 96100 for Work Comp cases (in California) and 99420 for all other carriers.


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## COMPauditor (Nov 5, 2013)

*Psychological Testing*

My pain docs are big on these.  We use CPT 96103 and basically this is an assessment of the patients mental condition.  The way we perform the test in our offices is by the patient answering a series of questions on a computer and then at the end of the questionnaire, the provider is given a score and from there he/she determines how the patient is "feeling".  Because of the specialty that we are in and the medications the patients are in, it is imperative that mental status is where it needs to be.

If 96103 is billed with an EM, we append a 25 mod on the EM and a 59 on the psych testing.  Refer to the LCD to determine the appropriate DX code.  We use Opioid Type Dependency dx codes 304.00-304.02.


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## SCCL5558 (Feb 18, 2014)

I bill for a Pain Management provider and it's for the PHQ-9 Test.


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## FractalMind (May 10, 2018)

*Psychological Pain Evaluation - Health and behavior assessment (96150-96155)*

Hi,

I know it's a tad late, but here are the guidelines for CPT range 96150-96155. The focus of these assessments is not on mental health but on the biopsychosocial factors important to physical health problems and treatments. These are not psychiatric diagnostic evaluations (unlike 90791-90792; 90832-90853).


*Guidelines for health and behavior assessment *

      CPT Assistant, March 2002 Pages: 4,5 Category: Coding Communication

      Related Information
Guideline and Code Descriptor Changes
Changes included in CPT 2002 are noted in the following. 

 Health and behavior assessment procedures are used to identify the psychological, behavioral, emotional, cognitive, and social factors important to the prevention, treatment, or management of physical health problems. The focus of the assessment is not on mental health but on the biopsychosocial factors important to physical health problems and treatments. 

 Health and behavior intervention procedures are used to modify the psychological, behavioral, emotional, cognitive, and social factors identified as important to or directly affecting the patient's physiological functioning, disease status, health, and well being. The focus of the intervention is to improve the patient's health and well being utilizing cognitive, behavioral, social, and/or psychophysiological procedures designed to ameliorate specific disease- related problems. 

 Codes 96150-96155 describe services associated with an acute or chronic illness (not meeting criteria for psychiatric diagnosis), prevention of a physical illness or disability, and maintenance of health, not meeting criteria for a psychiatric diagnosis, or representing a preventive medicine service. 

 For patients that require psychiatric services _(90801-90899 DELETED CODES, now --> *90791-90792*), _as well as health and behavior assessment/ intervention (96150-96155), report the predominant service performed. Do not report codes 96150-96155 in addition to codes _(90801-90899 DELETED CODES, now -->*90791-90792*)_ on the same date. 

Evaluation and Management services codes should not be reported on the same day.


 96150   Health and behavior assessment (eg, health- focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; initial assessment 

 96151    reassessment 

 96152   Health and behavior intervention, each 15 minutes, face-to-face; individual 

 96153   group (2 or more patients) 

 96154   family (with the patient present) 

 96155   family (without the patient present) 

     (For health and behavior assessment and/or intervention performed by a physician, see Evaluation and Management or Preventive Medicine services codes) 


*CPT Assistant © Copyright 1990-2018, American Medical Association. All rights reserved.*

And here's a clarification from CPT Assistant, March 2004 Page 10:
Question:

When are the health and behavior assessment codes used vs the psychotherapy codes? 

AMA Comment: 

From a CPT coding perspective, codes 96150-96155 are reported to describe those services performed to address difficulties associated with an acute or chronic illness, prevention of a physical illness or disability, and maintenance of health that do not meet criteria for a psychiatric diagnosis. Use of the health and behavior assessment codes eliminates inappropriate labeling of the patient as having a mental health disorder when the problem is actually a physical illness. It is important to note that the focus of these services is not on mental health but rather on the biopsychosocial factors affecting physical health problems and treatments.

*CPT Assistant © Copyright 1990-2018, American Medical Association. All rights reserved.*


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