Neurology & Pain Management Coding Alert

Question: A recent Medicare newsletter stated they will no longer reimburse for 96119 when we bill it with 96118 unless the physician provides the services in totally separate sessions. What's the latest news?

Vermont Subscriber

Answer: As of Oct. 1, NCCI considered 96119 (Neuropsychological testing [e.g., Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test], with qualified healthcare professional interpretation and report, administered by technician, per hour of technician time, face-to-face) as mutually exclusive to 96118 (Neuropsychological testing [e.g., Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test], per hour of the psychologist's or physician's time, both face-to-face time with the patient and time interpreting test results and preparing the report). 

You can bypass this bundling with a modifier, but a Medicare carrier medical director stated at the recent AMA CPT Symposium that it would need to be different tests performed on the same day in order to compliantly bypass this edit.

The Medicare carrier stance was that because 96102, 96103, 96119 and 96120 all include -with qualified healthcare professional interpretation and report- in the code descriptors PLUS supposedly when the RUC valued these codes physician work was included in the valuation, 96118 should not be reported in addition to 96119 or 96120 for the same test.

This conflicts with information the AMA published when these codes originally came out in January 2006, but it seems to be the most up-to-date information regarding the edits.