Neurology & Pain Management Coding Alert

Question: My neurologist has recently begun doing neurobehavioral testing, and says he can also do an E/M at the same time. Medicare states the E/M is included. Is this correct? Should the E/M be done at a different time?

California Subscriber

Answer: Although the two codes are subject to a Correct Coding Initiative (CCI) edit, they can be reported together, depending on the encounter performed and the documentation. CCI bundles neurobehavioral testing into the E/M services codes. You can use a modifier, such as modifier 59 (Distinct procedural service), to bypass the edit provided the testing is separate and distinct from the E/M service's exam portion

For the testing, use 96116 (Neurobehavioral status exam [clinical assessment of thinking, reasoning and judgment, e.g., acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities], per hour of the psychologist's or physician's time, both face-to-face time with the patient and time interpreting test results and preparing the report).

Contact individual insurance companies for individual coverage policies or limitations on 96116.