Neurology & Pain Management Coding Alert

Question: We do neuropsych testing with computer-based testing. When the patient comes for the initial office visit, the neurologist orders the test, and we bill an E/M code for her office visit. When the patient comes back on a different day for the test, a nurse practitioner (NP) usually stays in the room with the patient. Our neurologist does the final interpretation. Since the test is computer-based, what code should we be reporting?

Missouri Subscriber

Answer: You'll need to choose between two codes: 96119 (Neuropsychological testing [eg, 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) or 96120 (Neuropsychological testing [eg, Wisconsin Card Sorting Test],administered by a computer, with qualified health care professional interpretation and report).

The difference between the neuropsychological testing codes is "who" administered the test.

Code 96120 "should be reserved for situations where the computerized testing is unassisted by a provider or a technician other than the installation of programs or tests and checking to ensure the patient is able to complete the tests. If greater levels of interaction are required, though the test may be computer administered, then the appropriate physician or psychologist (96118) or technician code (96119) should be used," according to a November 2006 CPT Assistant article.

The CPT code for the computer-based testing will be dependent upon the amount of interaction and/ assistance the individual patient requires. You would report 96120 if your NP is truly only monitoring to make sure the patient completes the test. If a specific patient requires more assistance or guidance, however, then you would report 96119 as the NP is functioning in a technician role rather than a monitoring role. Have your NP make a determination of her involvement for each patient as it may vary depending upon the patient's needs and capabilities.