Neurology & Pain Management Coding Alert

Question: CPT 2000 code 96115 (neurobehavioral status exam) is time based. What are the coding guidelines for billing 96115 with evaluation and management (E/M) codes?

Delaware Subscriber

Answer: Code 96115 is a testing procedure that is reportable per hour and can be billed with E/M codes, states Catherine A. Brink, CMM, CPC, president of Healthcare Resources Management, Inc., a practice management and reimbursement consulting firm in Spring Lake, N.J., that consults with several neurology practices. If the codes are used with no modifier, either the testing or the E/M service will be denied on the grounds that one is included in the other. E/M services are paid in addition to procedures on the same day if the E/M is reported with modifier -25. This modifier states that the E/M service was provided on the same day for a significant, separately identifiable reason from the testing. This requires that different ICD-9 codes are used for the testing and the E/M service. The documentation for the E/M service must state clearly that the visit was not related to the testing.

Also, the reason for the office visit cannot be to discuss the test results. If the documentation supports the neurologist billing, the insurance carrier should not have an issue with retractions. Even if a carrier comes back for a retraction, however, the neurologist has the right to appeal.