Neurology & Pain Management Coding Alert

Question: Our practice includes a clinical psychiatrist (CP) who performs neuropsychological evaluations with the neurologist for movement disorders such as Parkinson's disease. Can the CP bill for these evaluations using the neurologist's diagnoses?

Virginia Subscriber

Answer: The CP cannot bill a neuropsychological evaluation (96117) using the neurologist's diagnosis.
 
CMS guidelines dictate that any procedure must be substantiated by medical necessity. In this case, there is no justification for the CP to provide the evaluation. The neurologist is treating the patient. A mental illness or neuropsychological abnormality must be suspected for psychological or neuropsychological testing to be medically necessary under Medicare regulations. Testing done when a mental illness or neuropsychological abnormality is not suspected would constitute screening and would not be covered by Medicare.
 
If the patient exhibits underlying psychological problems or symptoms that demonstrate medical necessity for an evaluation by the CP, those diagnoses (not, for instance, the diagnosis of Parkinson's determined by the neurologist) should be documented by the CP and reported with the appropriate CPT code for the evaluation. 

Diagnoses to support medical necessity include senile and presenile organic psychotic conditions (290.0-290.9), transient organic psychotic conditions (293.0-293.9), schizophrenic disorders (295.00-295.95) and others. Check with your local carrier for a complete list.