Neurology & Pain Management Coding Alert

Question: What rules apply to billing 96118 and 96119? I haven’t found many details from CMS other than confirmation that they reimburse the services. 

Connecticut Subscriber 

Answer: The biggest difference between these two codes is the person administering the test. If your physician administers the test, report 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 administering tests to the patient and time interpreting test results and preparing the report). 

If a technician conducts the test, report 96119 (Neuropsychological testing [e.g., Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scales and Wisconsin Card Sorting Test], with qualified health care professional interpretation and report, administered by technician, per hour of technician time, face-to-face). 

Remember: Both 96118 and 96119 are “per hour” codes, so you report the appropriate code multiple times if the tests last more than one hour.  Pay attention to how the code descriptors state you should count time: 

• Code 96118 includes both face-to-face time with the patient and time interpreting the test results and preparing the report. 
• Code 96119 only represents face-to-face time with the technician. The time spent in interpretation and report preparation is not included in the time associated with 96119. 

Student note: Some physicians allow their students to conduct the test and expect to bill 96119. You should only do this, however, if the student is also professionally trained as a technician to administer the test. If he isn’t, you’ll do better to have a physician or qualified technician administer the test instead.