Neurology & Pain Management Coding Alert

Question: Our provider performed brain mapping for a patient who had been in the hospital for a day. Notes indicate that prior to the brain mapping, the physician performed a level-two subsequent hospital care evaluation and management (E/M) service. How should I report my physician's brain mapping and E/M services?

Alaska Subscriber

Answer: For your claim, report 96020 (Neurofunctional testing selection and administration during noninvasive imaging functional brain mapping, with test administered entirely by a physician or other qualified health care professional [i.e., psychologist], with review of test results and report) for the brain mapping service. And that's it.

No E/M code? Remember to forget reporting a separate evaluation and management (E/M) code for the physician's pre-mapping service. If you report 99232 (Subsequent hospital care,  per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: an expanded problem focused interval history; an expanded problem focused examination; medical decision making of moderate complexity ...) with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) appended, the payer will deny the E/M.

Why? Below the descriptor for 96020 in CPT^® 2017, it reads: "Evaluation and Management services codes should not be reported on the same day as 96020."