Neurology & Pain Management Coding Alert

Question: What does functional brain mapping CPT^® code 96020 cover? And how do I report an evaluation and management (E/M) service on the same day as 96020?

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Answer: You shouldn’t code an E/M along with 96020 (Neurofunctional testing selection and administration during noninvasive imaging functional brain mapping, with test administered entirely by a physician or other qualified health care professional (ie, psychologist), with review of test results and report). Any same-day E/M work would be considered part of the 96020 package.

According to CPT^®, the 96020 code includes:

• “Selection and administration of testing of language, memory, cognition, movement, sensation and other neurological functions when conducted in association with functional neuroimaging;
• “Monitoring and performance of this testing; and
• “Determination of validity of neurofunctional testing relative to separately interpreted functional magnetic resonance imaging.”

Don’t code these: Since 96020 includes the great amount of work listed above, there are several restrictions on the code. CPT^® says “Evaluation and Management services codes should not be reported on the same day as 96020.”

CPT^® also reports these restrictions on reporting with 96020:

• Don’t code 96020 in conjunction with 70554 (Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body part movement and/or visual stimulation, not requiring physician or psychologist administration).
• Don’t code 96020 in conjunction with:

o 96112 (Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour) and +96113 (… each additional 30 minutes (List separately in addition to code for primary procedure)).

o 96116 (Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; first hour) and +96121 (… each additional hour (List separately in addition to code for primary procedure)).

o 96130 (Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour) and +96131 (… each additional hour (List separately in addition to code for primary procedure))

o 96132 (Neuropsychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour) and +96133 (… each additional hour (List separately in addition to code for primary procedure)).