Neurology & Pain Management Coding Alert

Question: One of our office RN staff performed a cognitive assessment on a patient consisting of general cognitive function, general cognitive proficiency,information processing speed, information processing accuracy, attention/mental control, reasoning/calculation,memory, spatial processing, and reaction time. Our neurologist completed a report of the results, but the physician had no face-to-face time with the patient. How should this be coded?

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Answer: These types of cognitive tests are often also referred to as neuropsychological tests. These tests are used to evaluate brain function for neurocognitive impairments, including such areas as memory and attention, the ability to understand and express language, and reasoning and problemsolving ability.

Neuropsychological tests can be administered by the physician/psychologist, by a technician, or by computer. CPT code 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) would be reported for cognitive testing performed by appropriately trained and supervised office staff,including your office nurses. You would bill one unit of service for each hour the documentation notes the RN spent face-to-face administering the neuropsychologic tests to the patient.

Medicare requires general supervision by a physician for neuropsychological testing unless it is performed by a qualified, independent psychologist or a clinical psychologist. Under general supervision, the procedure is performed under the physician's overall direction and control, but the physician's presence is not required during the performance of the procedure. Additionally, the training of the nonphysician personnel who actually performs the diagnostic procedure and the maintenance of the necessary equipment and supplies are the continuing responsibility of the physician.

Per the CPT parenthetical note, it would not be compliant to additionally report 96118 (Neuropsychological testing - per hour of the psychologist's or physician's time,both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report) for the interpretation and report of these technicianadministered tests. This code would only be separately reported if the physician additionally administered separate and distinct tests from those administered by the technician.

Clinical and coding expertise for You Be the Coder and Reader Questions provided by Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver.