Neurology & Pain Management Coding Alert

Two years have passed since neurobehavioral testing CPT codes (96100-96117) were moved under neurology, but many carriers still are confused about how to pay for these procedures. Thats not surprising. Although the neurobehavioral codes are now the property of neurology, they also are used by psychiatry and psychology.

The results of moving the codes under neurology have been mixed, says Antonio Puente, PhD, a University of North Carolina-Wilmington neuropsychologist who, as a member of the AMAs neurobehavioral CPT committee, helped draft the changes. Some companies refuse to pay neurologists who submit these codes for reimbursement because they say these are mental health codes. Some refuse to pay psychologists because they think the codes are for use by physicians only. Some payers think theyre psychiatry codes. More and more, were seeing companies say, Were not really sure where you belong.

But make no mistake. The codes covering neurobehavioral testing are medical codes, specifically neurology codes.

Neurology practices are most likely to use 96117 (neuropsychological testing battery with interpretation and report). Such tests include the often used Halstead-Reitan, Luria-Nebraska, WAIS-R and others. Neurologists usually use these tests to investigate the effects of brain injuries on cognitive abilities. These injuries may include cerebrovascular disease, delirium, dementia, depression with neurologic symptomatology, hydrocephalus, incranial neoplasm, learning disabilities, movement disorders, seizure disorders, substance abuse and traumatic brain injury.

Code 96105 (assessment of aphasia) should be used to diagnose aphasia. The most common test for this condition is the Boston Diagnostic Aphasia Examination.
When billing for the neurobehavioral status exam, neurologists should use 96115 (neurobehavioral status exam, with interpretation and report, per hour). This examination tests the patients thinking, reasoning and judgment.

Code 96111 (developmental testing; extended, with interpretation and report, per hour) should be used for developmental testing. This includes the Bayley Scales of Infant Development, which is used to evaluate motor, language and social development.

General psychological testing falls under 96100 (psychological testing, with interpretation and report, per hour). IQ tests, as well as personality and psychopathology tests, are included in this group. Although neurologists may use this code, some may have problems if they dont have a physical causation. Psychiatrists and psychologists are more likely to use this code, which fact may cause carriers to take a second look if its submitted by a neurologist. This code also can be used to diagnose organic brain syndrome (310.xx).

Again, neurologists must ensure they are using these tests to diagnose a medical problem. I see people with bona fide skull fractures, brain injuries, contusions, epilepsy and dementia. There is a clear physical etiology for the cognitive problem, says Jim English, PhD, a neuropsychologist who administers the tests for a group of 80 physicians at the Great Falls Clinic in Great Falls, MT.

English says that hes careful to always include the ICD-9 injury or disease code with the CPT testing code. When I do that, I usually see reimbursement requests sail through, he says.

Some other considerations when using these codes:

- Neurobehavioral testing is reimbursed by the hournot by the testincluding administration and interpretation. A 10-hour neuropsychology battery of tests typically includes eight hours of administration and two hours of interpretation, says English.

- With new tests being created all the timeand old tests being renamedcarriers occasionally will reject those that are unfamiliar. Ive had carriers reject tests because they say its not a neuro test. Theyre usually following an older book, and if they dont see the test in their book, theyre going to reject it. Theres a real lack of uniformity in what tests theyll pay for, English says. Therefore, neurologists should be prepared to support the medical viability of their tests.

- Dont use the DSM-4 codes. Use the ICD-9 codes. They go straight to the physical diagnosis, such as a skull fracture, says English. When neurologists use the DSM-4 the codes often are confused with psychiatry. You dont want to give the carrier any reason to label your patient as falling under mental health codes.

- Dont do maintenance testing. A stable patient with previously diagnosed brain dysfunction should not be tested just for a check up. To get reimbursed for a neurobehavioral test, neurologists will need to document a reasonable suspicion of a new problem or deterioration of the patients condition. Similarly, do not expect to get reimbursed when you use these tests for screening.