Neurology & Pain Management Coding Alert
Follow Guides for E/M With Health Assessments
Question: Our clinical social worker performs services (under physician supervision) that are listed in 96150-96155 or 98960-98962, depending on the patient. How should we report her services, considering that she does not have her own NPI number?
California Subscriber
Answer: Your question raises several issues, so ensure you know the ins and outs of the situation.
CPT 2007 states that you cannot bill 96150-96155 (Health and behavior assessment [e.g., health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires], each 15 minutes face-to-face with the patient ...) with an E/M code for the same patient on the same day. You can, however, bill these health assessment codes on a separate day incident-to the physician's service -- if your neurologist meets all the incident-to regulations.
You can report a code from 98960-98962 (Education and training for patient self-management by a qualified, nonphysician healthcare professional using a standardized curriculum, face-to-face with the patient [could include caregiver/family] each 30 minutes ...) with an E/M service on the same day if your providers meet the incident-to requirements.
Caution: CMS does not appear to cover these services. The patient must sign an advance beneficiary notice (ABN) authorizing you to bill her for the service before Medicare will reimburse you.
Neurology & Pain Management Coding Alert
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